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SOUTHERN ITALY 



AS A HEALTH STATION FOR INVALIDS 




NAPLES : 
RICHARD MARGHIER I 

140 Via Roma (formerly Toledo) 



[ The Right of Translation is reserved. ] 



SOUTHERN ITALY 

AS A HEALTH STATION 



SOUTHERN 



ITALY 



AS A HEALTH STATION FOR INVALIDS 




MEMBER OF THE AMERICAN MEDICAL ASSOCIATION AND OF THE 
MASSACHUSETTS MEDICAL SOCIETY; HONORARY MEMBER OF THE MEDICAL 
SOCIETY OF CALIFORNIA, CANADIAN MEDICAL ASSOCIATION, 
AND MEDICAL SOCIETY OF NEW BRUNSWICK; 
ASSOCIATE MEMBER OF THE OBSTETRICAL SOCIETY 
OF BERLIN, ETC. ETC. 




BY 





0* 




NAPLES : 



RICHARD MARGHIER I 



140 Via Roma (formerly Toledo) 




[ Tlie Right of Translation is reserved* ] 



NAPLES : GAETANO NOBILE 
PRINTER TO H. M. THE KING OF ITALY 



TO 

THE LATE WINSLOW LEWIS OF BOSTON, 
THE FIRST SURGEON TO EMPLOY ANAESTHESIA IN ITALY, 

AND TO ANOTHER, 

WHOSE DUST, LYING IN ITALY, 
HAS MADE IT THE AUTHOR'S HOME, 

IN LOVING MEMORY. 



This pamphlet is in great measure reprinted 
from a series of letters, during 1874, to the u American Reg- 
ister" of Paris. They were written in part, to -show that Ilaly 
may be visited with advantage by invalids , provided only 
reasonably cautious as to exposure and overfatigue, and in part 
to warn against the real dangers of the country, which belong 
not so much to its climate as to causes easily preventive, and 
which even so slight a contribution as this towards the spread 
of sanitary knowledge may do somewhat to remove. 

The letters are again placed before the public 
in the trust that they may meet with as favorable a reception 
as at first , and , it may perhaps be added , that they may 
accomplish an equal amount of good. 



Castello Monjoujou, Parco Grifeo, 

above Corso Vittorio Emmanuele, 
Naples, November 1875. 



CONTENTS 



PAGE 

General Considerations regarding European Health Resorts . . 1 

Southern Climate-Cures compared 12 

The Causes of disease in Italy . . . . . . .19 

The Types of Italian fever . . . 29 

Naples and vicinity as a Health Station 40 

Sanitary Claims of the Neapolitan Islands . . . . 50 

American Rate of Mortality in Southern Italy . . . .60 



ILLUSTRATIONS 



1. Naples. (Frontispiece) 

2. Ghiaja and Vittorio Emmanuele Quarters of Naples. 

3. Gastellammare. 

4. Salerno. 

5. Amalfi. 

6. Sorrento. 

7. Capri. 

8. Casamicciola. (Island of Ischia) 



Compelled , through personal invalidism of his own , to lay 
aside the cares of active practice at home , the writer has taken 
occasion to make a somewhat extended comparison during the 
past three years of the more prominent health resorts in Europe. 
He was induced to do this, not merely in the hope of benefitting 
his own case , but because the general subject of the relative 
merits of these resorts is becoming of greater and greater im- 
portance to American medical men, who are so frequently called 
upon to advise invalids as to the best place for their sojourn 
while in Europe. 

The investigation referred to began, as has been stated, in 

the main for personal reasons. Shortly after its inception, however, 

and in consequence of the kind interest taken by professional 

friends who had learned of his absence and its cause, the writer 

was appointed by the American Medical Association, at its session 

i 



at St. Louis in 1873, to prepare a formal report upon European 
Health Stations in their relation to American invalids. This report 
was rendered two years later, at Louisville, at the Annual Meeting 
of the Association for 1875. The present series of papers may 
be considered, with the report , as but introductory to a more 
extended statement, hereafter to be made. Prepared as they are in 
part, as answers to questions upon the subjects involved that have 
been put to the writer here in Europe by persons whom he has 
known at home , or who have for the first time consulted him 
since coming abroad, they might with propriety have been termed 
familiar letters from a physician, who is himself an invalid sear- 
ching for health , to his patients , though they are intended to 
serve a far wider purpose. 

So much preliminarily. It may be stated, as perhaps giving 
additional weight to opinions he may express , that the writer's 
experience in his profession covers something more than twenty 
years, and that the past was his fourth winter in Southern Eu- 
rope, a fifth having been spent in Great Britain. Three of the 
four winters referred to have been in Italy , and the fourth at 
Mentone. It will be perceived , therefore , that he speaks from 
some personal knowledge when discussing the question of relative 
climates, the more so in that, though his general standard of 
comparison must be New England , he has also passed a winter 
in the Southern United States, mainly in Texas. Should the dis- 
cussion hereafter extend beyond the so-called winter-cures to that 
of European health resorts for the warmer months, he may perhaps 
be able to draw practical and useful inferences from observations 
made during a summer in California, taken in connection with 



his five, thus far, abroad, one of which was in Russia, the second 
in Scotland , a third throughout Central Europe, and the two 
last in Southern Italy. It may also be mentioned that the con- 
clusions presented , in addition to having been based in great 
measure upon personal observation, have been corroborated or 
corrected by conference with European physicians who are either 
resident at the localities that will be spoken of, or who are in 
the habit of sending their patients thither ; in either case , their 
opinions being rendered authoritative from their having made of 
the subject a special study. 

It will have been noted that American invalids are particularly 
spoken of, as though the problem of health resorts in Europe 
were a different one for them than for English or Continental 
patients similarly affected ; and this, in fact, is true. Not merely 
does the relative shortness of the journey from Great Britain or 
the north of Europe, for invalids permanently resident upon this 
side of the Atlantic, materially modify the aspects of the question, but 
it will be found that there are other points involved, of paramount 
importance, that seldom receive the consideration that they deserve, 
either upon the part of sick persons or their advisers. 

It is a very great error , for instance, to suppose that what 
may be termed national habits of life — those pertaining to diet, 
kind and amount of under- clothing, and the like — can be safely 
left out of the account here any more than at home. Their neglect 
is often the cause of serious inconvenience, if not worse, to those 
who are well. Much more is this the case with invalids, to whom 
the change — to take a single example — from the cotton bed 
sheets to which Americans have been accustomed , to the linen 



ones here universal , means something more than mere and tem- 
porary discomfort. It is all very well to say that dyspepsia, that 
very frequent complaint in the United States, ought theoretically to 
be benefitted by any, whatever, change of diet, and that, therefore, 
it should be of little consequence to invalid travellers whether 
the water of a place can be safely taken, or whether they must, 
as it were , live upon wine , which perhaps they are tasting for 
the first time in their lives. Ideas of this kind effect a great deal 
of harm. Well persons who , like many foreigners , have been 
brought up upon nothing better, may, if they choose, take sour 
bread , but it cannot be safely d&ne by invalids ; and the same 
is true of the indescribable compounds so often presented at the 
Continental tables-d'hote. 

But why, it will be asked, do not these remarks apply with 
equal force to English and other European invalids as to Ameri- 
can. The answer is simple. The health-travelling of European 
invalids has become much better systematised than that of our 
own people who come abroad, and the laws that should govern 
it are more clearly understood , as to where the individual sick 
should go , their mode of life , and the duration of their stay , 
both by the mass of European patients and their medical attendants. 
At nearly all the great health stations upon the Mediterranean — 
if we speak of winter resorts — there are practising physicians of 
foreign origin, some of whom are resident there for the sake of 
the income it brings them, and some for the benefit of their own 
health. Thus, at San Remo, and Catania, and Palermo, there are 
German practitioners of great credit among patients from Northern 
Europe. At Mentone and Nice, Cannes, Hyeres, and Valetta, there 



are English physicians , whom Iheir countrymen may as safely 
consult as any in London, and it is to their skill in great measure 
that these places owe their repute as sanitaria. The truth is, that 
these gentlemen understand the typical constitution, both in health 
and disease, of their respective nations, and are thus enabled to 
prescribe the more intelligently and successfully for them. It is 
not merely from speaking the English language that the American 
medical men who are practising in Paris have so justly acquired 
their extensive clientele, nor because, in comparatively exceptional 
cases , they can serve as a useful go-between should a French 
physician be consulted; but it is because there are already a great 
many American . patients who are wise enough to appreciate that 
one who has lived in the same climate, been nourished upon the 
same diet, and had in most respects the same habits as themselves 
at home, can judge better than any foreigner as to what manner of 
life they had better lead, what things indulge in, and what avoid, 
when in Europe. The writer has so frequently been called upon 
by invalids whom he has met since coming abroad, to pass judg- 
ment upon opinions and advice that have been given to them 
by foreign physicians, that he has become satisfied that the point 
now made is an important one. ' 'An American" , it has been 
said to him," ought certainly to understand the constitution of 
American patients better than any foreigner." If this be the case, 
the sooner there are resident physicians of our own nationality 
settled at the more prominent places of health resort in Europe, 
the better it will be for our invalids who may come abroad. 
Even if he is known to be here for pleasure alone, an American 
practitioner can scarcely travel a week consecutively without being 



consulted by numbers of his countrymen. As yet, however, though 
American dentists, and pretenders claiming to be such, are now 
to be found in every corner of Europe, there seems hardly avai- 
lable, outside of Paris, a resident American physician. With the 
single exception of Rome , Cairo has been the next nearest 
point at which one has hitherto been stationed, but since these 
letters were written the gentleman referred to, Dr. Warren of 
Baltimore , who was occupying the high position of Surgeon- 
General of the Egyptian army, has been compelled by illness to 
at least temporarily relinquish his post, and to establish himself 
professionally at Paris. 

For the American invalid coming to Europe there exists a 
very great benefit that does not obtain here for others to the 
same degree, nor for himself so fully at home, and no matter the 
disease for which relief is sought , the remark still holds good. 
It is that here , as never at home , one can change the current 
of the thoughts , can shake off the cares of business , and the 
little frets of every day life, and thus ensure a mental and conse- 
quent bodily freshness and elasticity otherwise wellnigh impossible. 
The value of this towards regaining regularity of sleep and of 
digestion, and towards hastening convalescence from any chronic 
malady, whatever its character , cannot be over-estimated. It is 
this, in great measure, though all due credit should be given to 
the salutary influences of the sea voyage , and the interest and 
excitements of continental travel , in themselves considered , that 
exerts so powerful a remedial influence in cases that have already 
been sent to Newport or Saratoga, to Aiken or St. Catharine's, 
to Sharon, Jacksonville, or Minnesota, in vain. The limited change 



of surroundings, and of the thoughts, that may be had at home, 
are , of course , beneficial so far as they go , but they are of 
necessity comparatively imperfect. If they are all that can be 
afforded or otherwise obtained, it is not worth while to discuss the 
question; but the fact, none the less, remains that they but half 
present the curative measures that in many instances are to be 
desired. 

Upon this point, the variances of opinion that invalids find 
among medical men in the United States , as indeed in Great 
Britain, should all be duly allowed for. The physician who advises 
against the trip abroad should not be thought selfishly anxious 
to keep patients under his own charge , nor should those who 
occasionally send a case to the Continent be deemed thereby to 
pronounce it an incurable one, whose responsibility it were well 
to escape. With such instances, though they may at times occur, 
we are not now to concern ourselves. Different cases require 
different measures , but there still remain the abstract great 
advantages , to many forms of invalidism , of the transatlantic 
journey; in comparison with whose almost absolute mental rest, 
the possible discomforts of the voyage, now that sea-sickness can 
be partially obviated , should be allowed but little weight. So 
far as subsequent home-sickness is concerned , and the solicitude 
that must necessarily exist in most cases for the friends who have 
been left behind , these are but matters of time , that at any 
moment may be annulled — the last of them by the telegraph , 
and the first by returning home. 

Reference has been made to the difference of indication, as 
to coming to Europe or not, and to the Continent, required by 



different diseases or by individual cases of any single affection. 
The same is naturally true after arrival out here, as to the places 
of resort most advisable, whether for different maladies, or indi- 
vidual instances of a special disease. The reputation of health 
stations, here as at home, usually depends upon their having a 
peculiar or so-called local climate , mineral springs of one or 
another character , or medical men who have become widely 
known as safe advisers. Sometimes, however, and oftener appa- 
rently than in America , it will be found that a place greatly 
praised by one physician will be decried by another,-— perhaps in 
both cases for merely personal reasons; while, in other instances, 
the praise or disparagement has assumed an almost national 
character, The truth of this latter remark will be very generally 
recognised by those who have had occasion to consult both a 
French and a German medical attendant. The one will be almost 
sure to advise Algiers or Pau, Arcachon or Eaux-Bonnes, and to 
decry Teplitz, Karlsbad, Wiesbaden, Meran , and Gastein , while 
the other physician will be as certain to transpose the terms. Such 
has long been the case , though recent events may have served 
to intensify the relative measures of this international professional 
rivalry. 

In other instances , the destination of invalids during their 
period of medical treatment is often decided in accordance with 
the selfish desires or whims of their travelling companions. Thus 
Paris , to the well the centre of every pleasure , and permissible 
for the residence of moderate invalids, is found at certain seasons 
of every year to prove the death place of many infirm persons, 
who might in another locality have lived a longer time, or recov- 



ered. Thus, also, Nice, where there is so much to delight those 
who have the physical strength to bear its somewhat trying climate, 
and to indulge in the round of social excitements that it affords, 
each year proves fatal to individuals whose patience , or that of 
whose friends, could not endure the comparative quiet, or what 
the well sometimes improperly call stupidity, of Pozzuoli, Capri 
or Ischia. 

Dismissing for the moment the consideration of special resorts 
for special forms of ill-health, it will be perceived that the great 
aim has been to find a locality that might be best available for 
the general mass of health-seekers, considered strictly as such. It 
must be a place with a favorable climate , neither too hot nor 
too cold, too moist nor too dry, for the average invalid; a place 
where the ordinary comforts of life, such as Americans understand 
by the term , can be readily obtained , and without exorbitant 
expense ; where , with sunny exposure , one can find hotels and 
pensions whose rooms have fireplaces , with chimneys that will 
draw, carpets that are frequently shaken, beds warm and comfor- 
table, large and clean, and a table whose viands are selected for 
feeble digestions , well served and properly cooked. If, besides, 
such a luxury as double window-sashes has thoughtfully been pro- 
vided , it will be sure not to be despised by the American in- 
valid, who quickly learns that even southern climates have their 
draughts and occasional storms. There must , besides, be out of 
door pleasures that even the most delicate can enjoy. There must 
be walks and drives in the midst of interesting scenery, boating 
excursions, and chairs for an easy mountain climb. There must 
be flowers , and appetizing fruit , good drinking water , and the 

2 



— 10 — 

drainage of the neighborhood must be above reproach. If , in 
addition to all these requirements , the place visited for purely 
health purposes , is rich in historical and artistic material , and 
in other matters of outside interest, or is in the neighborhood o 
some large city that combines a multitude of pleasant associations, 
so much the better. 

The nearest approach to what has now been described, has 
generally been supposed to exist, as yet, only upon the Genoese 
Riviera, and especially at Nice and Mentone. So much has been 
said of these two places by many writers, professional and other, 
that no wonder the multitude in their search for health have 
stopped abruptly short of Genoa , fearing that by going further 
they might possibly fare worse. The impression that a more pro- 
longed journey must be at deadly peril , has so forcibly been 
given by Dr. Bennet of London , in his charming volume upon 
the winter climates of the Mediterranean # , that it may at first 
sight seem presumptuous for any one to claim that in Southern 
Italy there exist in even greater measure than upon the Riviera, 
many of the attributes that have been enumerated as necessary 
to a curative, safe , endurable , and thoroughly enjoyable health 
resort. If, however , it is recollected that in his search for such 
a locality, the writer has gone beyond the point at which Dr. 
Bennet , compelled to leave for the North again by reason of 

* J. Henry Bennet, M. D Winter and Spring on the Shores of the 
Mediterranean : or, The Genoese Riviera, Mentone, Italy, Corsica, Sicily, 
Algeria, Spain and Biarritz, as Winter Climates. London, John Churchill 
and Sons, 1870. 



— 11 — 

sudden illness, has repeatedly ceased his explorations of the Me- 
diterranean coast , the belief now ventured that those most in- 
terested may safely come and judge for themselves, may not seem 
an unreasonable one. Under these circumstances . even the ge- 
nial author referred to will pardon the statement , so opposed to 
his own, that invalids, under proper precautions, may, after all, 
be permitted to visit Italy. To return home without having done 
so, is, for the average American, the greatest piece of self-denial 
that can possibly be practised. 

How this can be accomplished by invalids, with equal benefit 
and safety, it will now be our task to set forth. 



II. 



In the previous letter allusion was made to certain special 
benefits that exist for American invalids who seek recovery upon 
this side the ocean, and certain special needs that, in their case, 
require consideration. It was stated that to ignorance or neglect 
of these latter, many avoidable deaths are yearly owing, and that 
in such a discussion it were unwise to forget the influence of 
nationality, alike in patient and attending physician. It was fur- 
ther intimated that while the choice of health resorts could not 
safely depend upon fashion, individual caprice, or the desires of 
healthy companions , there was yet a wider field from which 
profitably to select than has generally been supposed , and the 
opinion was ventured that there were Southern localities, as yet 
practically unavailed of during winter , which were well worthy 
attention. This latter remark was applied equally to invalids 
seeking a climate and local surroundings that would facilitate their 
convalescence, and to healthy persons desirous of spending some 
time in Italy without the risk of succumbing to its reputed dangers. 

In the selection of a climate cure, much must depend, in ad- 
dition to what has already been said, upon the character of the 
disease, its stage, and the temperament of the sufferer. The greater 
portion of what has yet been written concerning health stations, 
European as well as American , has pertained more especially 
to their fitness for consumptive patients. To a New-Englander , 



— 43 — 

it need hardly be said, the interest has been none the less upon 
this account , in view of the continuing ravages of the scourge 
referred to , despite all the suggestions made by science. Thus , 
at Boston alone, to take a single instance, the last official mor- 
tuary reports that the writer had received when writing the pre- 
sent letter, show the following startling proportion of deaths from 
consumption, as distinguished from all other forms of acute and 
chronic pulmonary disease. The reports cover five weeks during 
not a particularly fatal portion of the year, and there were in 
all 701 deaths. Of these, 117, or exactly one-sixth of the whole, 
were from consumption. What an exodus there would be from that 
portion of the country, and how, as a place of residence, it would 
be avoided by intelligent foreigners, were this proportion generally 
known to be nearly a constant one, in view of what obtains in 
more favored localities, as, for example, California. 

The fact that consumption has received such paramount at- 
tention from writers upon climate , is partly to be explained by 
the fact that most of the authors referred to have themselves also 
been persons who, on account of pulmonary trouble, have had, 
for a portion at least of each year, to live in the same exile that 
they counsel to others. This is, indeed , the case at the present 
moment with a large proportion of the English and German phy- 
sicians who are practising in Southern Europe. It is, of course, 
very natural , all the world over , for men to give the closest 
attention to such subjects as come the nearest home to them- 
selves. 

Be this as it may , it is necessary here to state that there 
obtains among physicians a very great diversity of opinion as to 



— li- 
the exact character of climate best suited for consumptive patients, 
whether at an early or an advanced stage of the disease. Almost 
all medical men , however , have been agreed upon one point , 
that in the vast majority of cases , after this malady has pro- 
gressed beyond a certain limit, the invalid had better remain at 
his home, wherever that may happen to be; it being ruled that 
nothing can at all compensate during the last hours of an almost 
hopeless illness, for absence from home comforts and from one's 
nearest and dearest friends. 

Dr. Bennet, of London, to whose delightful book upon the 
Mediterranean climates reference was made in the preceding let- 
ter, is almost the only authority of repute who has ventured to 
differ from this uniformity of professional opinion , and to hold 
out hopes of improvement and even of possible recovery under 
the conditions to which reference is now made. It must be 
acknowledged, and the writer states this after a winter's careful 
scrutiny of Mentone in its medical aspects , that there is strong 
evidence in favor of the great benefit possible in some cases of 
phthisis, however improbable entire recovery may be, to be de- 
rived from repeated and very prolonged residence at the place 
pronounced by Dr. Bennet the one single spot along the whole 
coast of the Northern Mediterranean that can be unqualifiedly 
recommended to consumptives. Physicians at Hyeres and Cannes, 
it is true, claim equal credit for those localities, but the exceptional 
advantages of Mentone , its sheltered position , especially in the 
Eastern bay , where the winds that so vex Nice and the rest of 
the Western Riviera are almost shorn of their force , and that 
peculiar solar exposure by which it becomes, as it were, the focus 



— 15 — 

of a largely extended concentration of reflecting cliffs, are points 
strongly in its favor, and now too well known to be here minutely 
described. There can be no question that Mentone must long 
remain the great resort of cases advanced in phthisis , at least 
during the lifetime of the physician to whom allusion has been 
made, for it has already been pointed out how much of the actual 
value, as well as of the reputation, of any given sanitary resort 
must depend upon the medical man or men who may have be- 
come identified with it. San Remo also , and Nervi and Pegli , 
must practically await their turn, although from what the writer 
has been told by Dr. Biermann of the. former of these stations, 
and from what he has himself seen , they undoubtedly possess 
exceptionally sheltered nooks , where the invalid who does not 
desire to go beyond his garden walls may nestle and keep tolerably 
contented. To these places , however , as to all others upon 
the Riviera, one cannot safely go until very late in the Fall, and 
must leave them again comparatively early in the spring. Having 
said thus much, any remarks that may now be made with regard 
to consumptives, and places of health resort in Southern Europe, 
cannot possibly be misunderstood. 

In discussing winter climates for consumptive cases , the 
distinction has been drawn , by none more clearly than by the 
author who has done so much for Mentone, between those which 
are very moist, those which are very dry , and those which are 
intermediate between these two extremes. Upon the Mediterranean, 
Corsica, Sicily , and Algeria have been mentioned as illustrating 
the first of these divisions , to which also belong places upon 
the Bay of Biscay , such as Arcachon and Biarritz , and some 



— 16 — 

that are comparatively inland , like Pau ; while in the second of 
them are more especially included eastern and south-eastern Spain 
and the Genoese Riviera. Each of these series of localities has 
had, and continues to have, its enthusiastic advocates. For certain 
classes of patients each is thought to possess its distinct advan- 
tages , and for others its as distinct disadvantages. Every rule , 
however, has its exceptions, and it is not always safe to predi- 
cate that because a local climate suits one case it must answer 
equally well for all that seem similar to it. In point of fact , it 
will probably prove true that there are isolated localities , in 
climate midway between the two extremes of excessive dryness 
and excessive moisture , such as a portion of Southern Italy is 
acknowledged to be , that are adapted for a large proportion of 
both the classes of cases referred to above. A certain amount of 
weight, as to this, must be allowed to the sensations of patients 
themselves ; and, while an over-exhilarating atmosphere may prove 
deadly to those whose vital powers are at the lowest ebb , so , 
on the other hand , may an excess of enervation from external 
causes. For many invalids , an appreciable degree of stimulus is 
as necessary in the air as it is in their food. The only point is 
that its benefits should not be neutralised by careless over- 
exertion or exposure while under its influence. Comparatively few 
patients require simply a greenhouse treatment, and it has already 
been shown that the medium course is often the best between 
the dulness and seclusion of a purely hospital town and the ex- 
citements of a bustling city. It is this fact that so often neutralises 
the gain that might be obtained in many cases by staying at 
home , and in others by going upon a very long sea-voyage , 



especially in a sailing vessel , as to New Zealand or Australia. 
Sameness of surroundings may depress, just as too constant and 
violent change may unduly excite. 

It is no doubt to the individual circumstances of each sepa- 
rate case that much of the conflict of testimony regarding diffe- 
rent health stations is to be attributed. One patient finds benefit 
at the Channel Islands, and another in the Tyrol, while a third 
decries them both — in each instance the question having been de- 
cided by the choice of an inn , perhaps , or the outlook of a 
bed-chamber. It is so also with places nearer home. Thus, Fayal, 
where so many consumptives are now sent from New England , 
is thought the most charming place in the world , or the most 
disagreeable, according as each invalid happens or not to receive 
the hospitable attentions of a certain resident American family. 
A similar discrepancy of testimony has obtained with reference 
to Madeira, which has so long served the same purpose for Eng- 
lish consumptives as the Azores for American. 

A purely insular climate , like those now mentioned , and 
others of equal repute — Havana and Nassau, for instance — must 
of course be comparatively a moist one, and in many cases too 
much so ; a great deal, however, depending upon the size and con- 
tour of the island , and the dryness , or rather porosity , of its 
soil, which last point, it has been suggested to the writer by a 
Scotch lady resident there, may in part account for the delightful 
winter climate of Ischia. The disadvantages of too great humidity 
are naturally enhanced when combined with an excess of heat too 
evenly distributed through the day and night , as in the West 
Indies and Florida , while , upon the other hand , provided the 



— 18 — 

invalid be but safely housed sufficiently early, a very great chill 
may regularly occur after sunset, without any harm, and perhaps 
with decided benelit. This is the case upon the Riviera , where 
blankets are necessary throughout the winter, and sleep is so re- 
freshing ; and it also obtains in California, portions of which the 
writer unhesitatingly considers the best places for consumptives 
in North America , for they are neither too moist nor too dry , 
too hot nor too cold, and withal extremely equable in both respects 
throughout the year. 

An approximation to these conditions exists in Southern Italy, 
to reach which by the ordinary routes of travel a gauntlet of 
dangers must be run by invalids. These, for Americans, can be 
escaped in a great measure by the direct voyage into the Medi- 
terranean; extended and fatiguing land travel, such as is otherwise 
necessary, being much better reserved until convalescence has been 
established. 

Upon these points, however, there remains much to be said 
hereafter. 



III. 



Thus far the writer has confined himself to pointing out that 
for invalids seeking convalescence in the South of Europe , it is 
by no means necessary, as some authorities upon the subject have 
contended , that they should debar themselves the pleasure of 
visiting Italy; and that the northern route, through the Continent, 
is not for all cases the easiest or the wisest course by which to 
reach this most interesting of lands. The remarks made upon 
these points, there was occasion taken to state, apply more par- 
ticularly to delicate persons, as distinguished from hopeless cases 
of invalidism ; but even for these, provided only it has been once 
decided that home is to be left , it is possible so to time their 
arrival, that even if a portion of their stay is to be spent upon 
the Riviera, two or three months may yet be pleasantly and pro- 
fitably given to the South. 

It may be objected that this could hardly hold true with 
reference to an autumn like the last but two , when the whole 
of Southern Italy had the reputation of being ravaged by cholera. 
Let alone, however, the fact that at Naples there were not nearly 
as many cases of the epidemic as was at first imagined , and 
these almost without exception among the lower classes and in 
portions of the city not lived in by foreigners ; and that at Sor- 
rento there were but two cases, both imported, — and at Ischia 
not more, — it must not be forgotten that of the more northern 



— 20 — 

portions of the Continent there were none that in reality, in pro- 
portion to the number of inhabitants , were less under the in- 
fluence of the disease. Paris , Dresden , Vienna , St. Petersburg, 
and Munich were all acting as initial points for its dissemina- 
tion, and the traveller, by car or by diligence, who came within 
an hundred miles of either of these cities , was as liable to be 
exposed to danger as if quietly residing here at the South ; the 
only difference being that certain old-fashioned and useless pre- 
cautions, — fumigation at the railway station, for instance, and the 
slitting and smoking of postal letters, — were not, save at Rome, 
allowed to add their weight to other sources of terror. Under 
the new regime , Southern Italy is year by year awakening to 
the possibility of curtailing epidemic as well as the ordinary forms 
of preventible disease, and there now seems reason to believe that 
at no very remote period even that Augean stable , the city of 
Naples , may be made and kept quite clean. Putting aside then 
the chance of cholera , as one that existed at Naples only in 
common with other great Continental seaboard and inland cities, 
it will be of interest in this connection to inquire as to the actual 
risks of added disease that invalids run who may desire to visit, 
for a longer or shorter period, charming Southern Italy. 

The risks referred to , real or imputed , such as they are , 
are of a three-fold character, according as they are inherent in 
the country itself, or its several cities , or pertain to the natio- 
nality of the invalids for whom these papers are written. 

In the first place, diseases depending upon the Italian climate 
may be summarily disposed of by saying that they are much the 
same as belong to our own southern and south-western States, 



— 21 — 

and can in great measure , as there , be prevented by the same 
prophylactic or precautionary measures as would be indicated by 
his physician to a traveller undertaking such a journey at home. 
Italy , throughout , must be considered as a malarious country. 
Milan, Genoa, and Florence, and the districts outside them, just 
as Rome and its Campagna, give rise to intermittent and remit- 
tent attacks, provided the stranger is indiscreet or does not in- 
telligently protect his system , precisely as would Cleveland or 
Chicago, St. Louis, or even Staten Island. With these cities, as 
with those, the liability increases and lessens in accordance with 
the season at which the visit is made ; Italy having in this respect 
a very great advantage over most portions of our central and 
southern States , in that there are salubrious stations in close 
proximity to even its most unhealthy neighborhoods, at which the 
very hottest months of summer may be passed with comfort and 
safety. 

Were the risks of malarial fever the only ones that might 
deter invalids from visiting Italy, there would be but little more 
to say regarding the subject of general and climatic, as contra- 
distinguished from purely local, sources of danger. Everywhere , 
however , in Italy one must be prepared , according, of course , 
to the season, against the extremes of heat and cold. Yet this is 
not much more the case than throughout the south of France. 
The wise traveller carries his two-fold protection with him — a 
white or, at any rate, very light-colored sun-umbrella , colored 
spectacles and. an abundant supply of warm clothing , in which 
there must be included flannels and woollen stockings , as well 
as outer garments and journeying wraps. To a neglect of these, 



— 22 — 

at least one-half of all the yearly sickness among foreigners in 
Italy may be very safely attributed. People so begrudge having 
to pay the rail for its transport of all their luggage, even if the 
expense with this included amount to no more than the usual 
rates of fare at home, that they instinctively try to economise by 
leaving it behind them, or at some station or city upon the route, 
to which they expect to return. To do this often costs them very 
dearly in the end. Forgetting the contrast of shade to sun , of 
evening to midday, and of the interior of churches and galleries 
to the outer air, they incur all sorts of exposures in their walks, 
and drives; just as they so often do in their hotels by allowing 
themselves to be placed for weeks or months together in rooms 
looking north, chilly and damp, because without one particle of 
sun — a combination of influences, than which nothing is more 
certain to produce disease in the well, and to aggravate it in those 
already invalid. And yet how constantly people wonder at the 
sickliness of this country when they find themselves attacked by 
pneumonia, bronchitis or pleurisy, rheumatism, or even diphtheria. 

Secondly , one hears constantly of so-styled local diseases 
here in Italy , pre-eminent as it were above all others — such , 
for instance, as Roman , Florentine , and Neapolitan fever ; and 
it is a question, indeed, if the great majority of foreigners coming 
hither do not half expect to be made their victims before com- 
pleting the circuit of their journey. Regarding all this , with a 
certain measure of truth, there is mingled a great deal of error. 
Dismissing from present consideration those purely- malarial forms 
of fever which have already been mentioned, and simply adding 
that in Italy, almost every type of disease whatever is quite sure 



— 23 — 

to present in addition one or another malarial symptom , there 
remain certain other forms of fever , often very severe and at 
times fatal, to which the local appellations instanced above, and 
at other times the general terms of "continued" or "pernicious" 
fever, are ordinarily given. Studied with care, these cases almost 
invariably resolve themselves into instances of "enteric" fever or 
''typhoid", a disease strictly non-contagious in the proper sense 
of that term; for true "typhus", the contagious, spotted, or 
ship fever, though it occasionally has its outbreaks of greater or 
less intensity, is here as elsewhere, save in the close dens of the 
very poor, comparatively unknown. But it must not be forgotten 
that we have at home , at certain seasons of the year , and in 
some years at all seasons , almost precisely the same forms of 
disease. The variously styled slow fevers of our South and the 
typhoid of the North , seem just as prevalent , and treated with 
the utmost discretion they often prove as fatal. Besides , there 
can be no question that Rome and Florence , and even Naples , 
are each credited with many more cases of fever every year than 
really belong to them. 

[The ink was scarcely dry with which the above words were 
written, when death overshadowed the writer's own household. 
By strange coincidence, it was fever — sudden, intense, and wholly 
resistless , despite the efforts of skilful professional friends — 
Sorrentine, English, and Neapolitan — who gave their aid. The 
dearest of all, at whose suggestion it was that these letters were 
commenced, was taken. 

Several months afterwards, and this time, indeed, as a labor 
of love, the notes were once more gathered in hand, for careful 



— 24 — 

revision , and with the determination to change or even erase 
every statement already made that could not bear the added light 
of such bitter experience. 

The first impulse under such circumstances would be, hastily 
to pack one's trunks and flee, lest there might occur a repetition 
of the calamity. It seemed, however, the better course to remain, 
and to subject the climate to a still more searching study. Another 
year has now passed, and of one thing the writer remains quite 
certain , that there are localities in Southern Italy where , with 
proper precautions, the risks of self-originating fever are not so 
great as has been generally supposed to obtain throughout the 
country. At Sorrento , for instance , while there were many fe- 
brile cases, of greater or less severity, during the eight months 
of his residence there that originated elsewhere, or occurred im- 
mediately after arrival , as a sequel to prolonged residence in 
unhealthy portions of Rome or Naples, there occurred but a single 
instance, the one alluded to above, where the disease was fairly 
initiated without any such previous history ; while malaria , as 
such, is practically unknown.] 

Beyond this one point, the risks of fever, the discussion of 
which will now be resumed, what has hitherto been written may 
stand; with but the addition of a word or two with reference 
to very delicate chest cases, such as the writer has already advised 
to spend a portion at least of each winter upon the Riviera. If 
willing to endure the somewhat close seclusion for several months, 
they may safely go to Amalfi, that lovely nook upon the southern 
side of the Sorrentine peninsula, or better still to Pozzuoli, where 
confinement within contracted bounds may be made sufficiently 



— 25 — 

bearable. Generally , it may be said that while the Southern 
summer , especially at Capri and Ischia , is well adapted for 
such cases, consumptive patients should hardly visit Naples, still 
less Sorrento , until late in the spring , or the rainy season is 
entirely over. This should certainly be the case in an unusually 
inclement winter like the past. With every year , however 
greater and greater provision for the comfort of every kind of 
invalids may reasonably be expected to be made at the hotels ; 
and under the new government , comparatively so progressive, it 
will not probably be long before there will be introduced better 
systems of water supply , sewerage , and cultivation of the soil 
where fertilisers are employed ; connected with which latter point 
there exist dangers to health throughout Southern Europe , that 
do not seem to have been pointed out by sanitary writers, or even 
imagined — the applications made being often a purely surface 
dressing, without the least effort to cover them with a thin layer 
of earth, still more to intimately mingle them with the soil. 

As to the disregard of public decency, involving also a danger 
to the public health, which is everywhere observable in Italy , 
sufficiently stringent laws already exist for its suppression , the 
only trouble being that they are not enforced. Almost everywhere 
there are public latrines, the houses of the common people being 
frequently unprovided with even the most primitive of such con- 
veniences, but they are not always employed. Even at Sorrento, 
a town unusually well kept and clean, there was such room for 
improvement in this respect, that the writer of these letters took 
occasion, through the Medical Society of the district, of which he 
is now a member, to address a communication to the Municipality, 

4 



— 26 — 

calling its attention to the fact that English and American tra- 
vellers, with whom questions of health are beginning to receive 
their due attention , and upon whom these towns have come to 
depend so largely for their support, have a right to expect that their 
own standard of public cleanliness, and not the ordinary Italian 
one, should be observed. When this shall have been made the 
rule at all the great travel centres of Italy, their annual rates of 
sickness will be materially cut down. 

It is in causes like these that lie the chances of typhoid fever ; 
chief among them all , imperfect drainage , often far worse than 
none. In these old cities , sewers and cesspools that were built 
centuries since and their very existence forgotten, or whose outlets 
have become long since completely occluded, are allowed to remain 
in connection with those now in use, and thus serve as constant 
sources of danger. Others, of modern construction, are long left 
without repair , although giving off the most offensive effluvia. 
This is often the case under circumstances where one would 
suppose it would be impossible , in view of the interests of all 
concerned. It is no uncommon thing at many of the hotels on 
the Continent most patronised by the better part of the travelling- 
public , to notice this deadly odor of the drains , especially at 
night. Wherever such is the case , that hotel is to be shunned 
as one would a pestilence, no matter what its reputation or the 
excuses offered by its proprietor ; and this is true, however slight 
the odor , if in the faintest degree it exist. Every physician's 
experience is fruitful of fatal cases of typhoid thus occasioned. 
To the memory of most Americans, the terrible mortality at the 
National Hotel in Washington , a few years since , will serve as 



— 27 — 

an instance in point. It may be laid down as an imperative rule 
to avoid all hotels with the fault just mentioned, all under any 
portion of which there is a stable in use, all whose water-closets 
ventilate into the public entries , and all which have been very 
recently built or extensively repaired, and whose thick walls have 
therefore not had time to dry. It may seem needless to urge such 
precautions as these, the importance of which will appear so very 
evident , and yet the writer knows of many hotels , crowded 
annually by his countrymen , at which these great dangers are 
present, and have often proved fatal. They are to be found not 
in Naples alone, but as well in more Northern capitals. That they 
do not kill so many there as here is through no merit of their 
landlords; were only the climate equally tropical, they would be 
sure to do so. 

At Naples, besides, there exist a rainy and a rainless season, 
and an almost tideless sea. Clogged as the sewers become through 
the summer , there are evolved , when the rains do come and 
flush them, exhalations as poisonous as those of Vesuvius itself; 
and this, at intervals, for months together. The scourings of the 
drains lie long just outside the shore — in certain winds, for many 
days — infecting the air as it enters the town; and this state of 
things is increased by the three long break -waters which extend 
into the sea. For these reasons it is not at all to be wondered at 
that old residents, who have become thoroughly acclimated, and, 
as it were, casehardened, yet advise an occupancy of upper stories 
alone in what till of late has been the most fashionable quarter. 
At Naples , even more than in Rome , exact locality becomes of 
the very first importance, whether one's visit is to be for a day, 



— 28 — 

a month , or a year. Some of the hotels , though enticing and 
admirable to all appearance , are noted for the almost constant 
presence of fever ; and some of the private houses with suites 
of apartments to let, though situated in the most fascinating part 
of the city, would be far too dear even if offered as a gift. 

This premised — and remembering that much of the febrile 
disease that occurs is occasioned, here as elsewhere, and certainly 
so far as concerns a predisposition to it , by fear , and that , 
should it threaten , the attack may often be cut short , or pre- 
vented, by a timely resort to appropriate measures, or by removal 
to the healthier locations across and out in the Bay — we may 
begin to consider more in detail the special advantages offered 
to the invalid by Naples and certain places thereto adjacent. 



IV. 

It has been shown in previous letters that Southern Italy 
has much to recommend it to invalids in search of health. It 
was incidentally suggested that particularly was it best, in many 
cases , that the voyage hither by Americans should be made 
directly from home, to save the fatigues of the journey through 
England and France, even if the Mediterranean should be crossed 
from Marseilles. When the route* from Paris is made wholly by 
land, or by sea from Genoa, still more would such be the case, 
until, at least, our American sleeping-cars shall have been more 
generally introduced. A word or two further upon this subject 
may not be out of place. 

Americans returning from Europe almost always wish to 
spend their last moments on this side the water , in Paris or 
London. Especially is this true of ladies, to whom the demands 
of the final shopping are well nigh inexorable. Upon departure, 
moreover, the universal wish is to shorten the voyage by every 
hour possible. The case is very different however with the outward 
bound. To them, with a year or two of absence in prospect, a 
few days longer upon the water will make but very little differ- 
ence , and if , besides , it may save them from that necessity of 
retracing their steps , which most travellers to Italy have to 
endure — at the same time that it ensures a visit to the most 
ascinating region of Europe — the point becomes well worth while 



— 30 — 

to consider. At present , the arrangements for reciprocal steam 
transit between Italy and North America are far from complete. 
There exists but a single line of steamers upon this route , a 
branch of the Scotch Anchor Line. A new and strictly American 
line is talked of , to be sure , but as yet it remains among the 
possibilities. The Anchor boats are good — we speak from personal 
inspection — clean , airy, very commodious, and with decks tate- 
rooms. Their course westward is a southern one throughout, and 
therefore less liable to collisions at sea , while the trip allows 
passengers to spend a day or two on shore at Gibraltar and one 
or another of the Sicilian ports. The voyage, with equally good 
accommodation, is withal somewhat cheaper than by the northern 
lines , immensely so if the whole cost of the journey hither is 
taken into consideration. But a single fault exists — that, while 
the steamers go directly from Naples to New York , affording a 
delightful voyage for the homeward-bound, passengers from New 
York cannot be brought at once to Naples, but though they can 
ticket completely through, must yet change steamers at Glasgow 
or an intermediate stopping point — this being the effect of existing 
currents of trade. It is to be hoped, however, that arrangements 
will yet be made as convenient for outward-bound passengers 
from America as for shippers of goods. 

That in default of direct steam communication , the voyage 
from the States to the Mediterranean may yet be very agreeably 
made by sailing vessel, the writer can testify from his own per- 
sonal experience of many years since. Two or three weeks longer 
are spent at sea, but, to counterbalance, certain discomforts inse- 
parable from steam navigation are avoided. 



In the last letter there were discussed the risks of acquired 
sickness to which travellers , especially the invalid , are exposed 
in Southern Italy. Upon this point also, a few additional words 
may be said. It has already been indicated that many of the 
dangers of illness to which visitors are liable, are only those that 
are everywhere found in subtropical climates , at home as well 
as here. This is especially true of the water used for drinking, 
for there are still Americans to whom a glass of good water is 
as preferable, even when abroad, to wine, as it is at home ; and 
those who flatter themselves that by taking no water at table 
they can escape all its risk , forget that they are by no means 
sure that the water which reaches them in their food from the 
kitchen is at all pure, either naturally, or by having been brought 
to the boiling point. 

Reference has been made moreover to the frequent pollution 
in Italy of the water supply. This country abounds, besides, from 
one end to the other, with mineral springs, some of which, though 
medicinally quite powerful, have but little appreciable taste. Their 
waters are constantly supplied to the traveller , at table or in 
his chamber, through the landlord's ignorance of their true char- 
acter , or his belief that they will probably do no harm , but 
they often produce a decided effect. Thus, to give a single instance, 
the writer has been repeatedly consulted by persons who had 
been staying a few days or weeks at Castellamare , and though 
they had not visited any of the springs there as such, vet almost 
all of them had suffered severely from diarrhoea. The cause of 
this was evident enough , though by the patients themselves it 
had not been suspected. In Rome it is advised to drink only 



— 32 — 

Trevi , or rain-water collected in cisterns from the roof , the 
greatest precautions being taken in the latter instance against its 
defilement by the poultry and doves, dogs, cats and rabbits , so 
often kept upon the tops of their houses by Italians, in Naples, only 
that from the Leone spring. In how many instances however 
is it to be supposed that hotel keepers are at the trouble or 
expense, for this latter is often involved , to protect their guests 
from this source of illness. Were Artesian wells at all relied upon 
at Naples for the supply, as at Paris, the water would probably 
prove , even more surely than there , of a decidedly medicinal 
character, as is the case with the present Santa Lucia and Piz- 
zofalcone springs, — for some invalids beneficial, but certainly not 
so for all , and not to be taken at random , or without a very 
good reason therefor. There are places, however, of which Sor- 
rento is one, where the water in almost every part of the town 
can be drunk with the same safety as at home. The great hope 
of Naples in every sanitary sense, lies in the speedy completion 
of a proper aqueduct from the neighboring mountains. At present 
the united protests of the travelling public should be employed 
to compel landlords to pass all their drinking water through a 
charcoal filter , this being considered by physicians the surest 
disinfectant. Were every stranger to carry as a part of his ordinary 
luggage a small portable filter of the kind referred to, occupying 
scarcely six inches of cubic space, a vast amount of disease would 
annually be saved. 

In speaking of the causes of "continued" fever — one variety 
of which, the typhoid or enteric, comprises so large a proportion 
of the severe illnesses of foreigners in Italy — those only have been 



— 33 — 

mentioned which are common as well to more northern climates, 
or at least are not unfrequently there found. The effect of the 
Southern sun, however, must not be forgotten, for there is good 
reason to believe that direct exposure, especially if prolonged, to 
its rays, is often the cause, not merely of sunstroke, but of con- 
tinued fever, of another variety than the ordinary typhoid to be 
sure, but in this Southern Italian climate not less severe at times, 
nor less fatal. Even if forewarned of the Italian proverb, which 
classes strangers with dogs, from their seeking the sun in winter 
when at its height, it is very hard for people to appreciate that 
between chilly shadow and burning glare, the former is frequently 
the least of two evils, for it can at least be more easily guarded 
against. The point now made is a very different one from the 
chance of taking cold, and thus initiating, or aggravating, disease 
of the respiratory organs , by the change from one to the other 
extreme , to which allusion has previously been made. It is the 
opinion of many medical men familiar with warm climates, that 
this form of continued fever — called ''simple" by English physi- 
cians, when comparatively ephemeral, and "ardent" when severe; 
and by the Italians again "rheumatic" fever, though it is shorter 
and in every way different from the disease that is known by 
that name in America — originates, without need of seeking for 
other cause , from simple exposure to direct solar influence , 
especially when one is under the effect of fatigue. This, of itself, 
seemed to occasion much of the illness in the late Ashantee cam- 
paign. Isolated cases like those we are now considering, would be 
often likely to be attributed to other than the real cause, so uncon- 
scious people often are of the risks that they may be incurring. 

5 



— 34 — 

When true "typhus," the contagious form of continued fever, 
occurs among clean and respectable persons such as the ordinary 
traveller , but a single cause need be looked for. It comes from 
contagion alone ; by one individual directly transmitting the disease 
to another. If ever self-originating or sporadic , it is only so in 
the crowded dens of the poor, in army barracks, and in prisons, 
or upon shipboard. If, therefore, a landlord should seem to 
express undue wonder that any given case should have occurred, 
this should be considered reason enough for inquiring whether , 
just as with small pox and scarlet fever , there may not have 
recently been another patient of the kind in the house , and 
perhaps in the very same room, the true nature of whose disease 
will most likely at the time have been kept concealed. Here, too, 
the physician finds that but few travellers appreciate the risks 
that they daily run, or know, unless by bitter experience, that 
the chances are all in the innkeeper's favor. Should it ever be 
attempted , as in fact is often done at hotels , to send the sick 
person out of the house, nominally , of course , for the sake of 
other guests, or to collect an unreasonable sum for the privilege 
of remaining, protection against these dangers may be sought from 
one's Consul ; and if the threat should be carried out, exemplary 
damages could undoubtedly be recovered , even in this country , 
by a suit at law. Landlords have their privileges, it is true, and 
their position is not always an easy one , but there are rights 
that belong to their patrons also. It is a fortunate thing for all 
concerned, that true typhus, even in Naples , is extremely rare, 
and it whould be well for travellers to remember that the nom- 
enclature of febrile diseases employed by Italian physicians is 



— 35 — 

very different from that accepted by both English and Americans ; 
the word "tifo" as here constantly used, being made to include 
both the infectious typhus, and the non-contagious, self-limited 
typhoid. 

In an earlier letter, the question as to whether Naples and 
its neighborhood could be safely recommended for consumptives, 
received attention. The opinion was ventured that for these cases 
it was better suited during the late spring , and throughout the 
summer , than during winter. A study of Naples for now two 
years has convinced the writer that the only safe place for stran- 
gers, — and the remark is intended as a general one, not for the 
sick only , but for the well, — is upon the mountain-side above 
the Chiaja, upon or in the immediate neighborhood of the Corso 
Vittorio Emmanuele. Absolutely sweet and clean as compared with 
the lower city , there are portions of the Corso fully exposed to 
the sun and yet perfectly sheltered from the prevailing North and 
North-easterly winter winds. For chest cases this is of course a 
matter of paramount importance. There are besides, places in the 
vicinity , elevated and dry , yet sufficiently hot by day and cool 
by night , such as Pozzuoli for instance , which are infinitely 
better for delicate persons who may come here , than to send 
them even by sleeping-car the long journey inevitable to reach 
any appropriate Northern health station. As to very bad cases, 
they would do better in winter at Mentone , or in Egypt ; but , 
if coming to Naples, there are one or two suggestions it may be 
well to make for the sake of their friends. The southern Italians, 
as a people, have a strange horror of consumptive patients. They 
believe the disease contagious, and always mortal. Even the Italian 



— 36 — 

physicians seem very frequently to share in these opinions. At any 
rate, though as a rule they are better practitioners than foreigners 
are apt to give them credit for , they are here prone to express 
the most unfavorable view, and they do not always resort to the 
measures that are most relied upon by the rest of the medical 
world ; the truth being, as was intimated in a former letter, that 
in an appreciable proportion of these cases , a permanent arrest 
of the disease becomes possible, if not indeed complete restoration 
to health. The point we are making in the present connection is 
this: the Italian hotel-keepers, as a rule, dislike to receive con- 
sumptive patients , and , in case of a fatal result , just as with 
fever patients , they are inclined to make exorbitant and special 
charges. This is a danger that, like those we have already indi- 
cated can best be escaped by conference with one's Consul, who, 
being versed in what the law does and does not permit , can 
easily remove all chance of conflict. 

Having thus discussed, at some length, the general relations, 
positive and comparative , of Southern Italy as a place of resort 
for invalids, it remains for us to consider what special advanta- 
ges, to counterbalance its dangers, it may possess. 

A word may be said , in the first place , with reference to 
the attractions that Naples affords the well; for to them, just as 
to the sick , applies the question whether it is safe to venture 
hither. It is generally the case that the Neapolitan visit is a very 
flying one, extending merely to two or three days, or possibly a 
week. The Museum is seen, the Palace* the Convent of San Mar- 
tino , San Severo's Chapel , and perhaps the view from Capodi- 
monte. Vesuvius is of course climbed) Pompeii visited; and then, 



— 37 — 

if the traveller's dread of illness permits so long a stay , a day 
is spent in visiting the grotto at Capri, with perhaps a night at 
Sorrento or Ischia and, in very exceptional cases, there is added 
the trip to Amalfi and Psestum — and then Naples is supposed to 
have been completely exhausted of its interest. 

This is far from the case , however , no matter what one's 
special taste may be. The student of languages will find much 
to interest him in its dialect , so many of whose words are of 
direct Greek origin , and differ from those used in Central , and 
still more in Northern Italy. For the lover of art, the Pompeian 
Schools have more than a momentary attraction. The antiquarian 
can nowhere find a richer field. There are most interesting discov- 
eries awaiting the historian who cares to sift the vast public 
and private libraries and collections of manuscript. There are 
unrivalled subjects for the painter of land or sea. For the student 
of natural history, there is the finest aquarium in existence, with 
most admirable laboratories attached for private research ; while 
every step that the geologist, mineralogist or botanist may take 
upon this enchanted ground will be found to afford the most 
satisfactory results. 

These things are all of them valuable for the well. Still 
more so in the case of the partially invalid , who so often find 
it difficult to pleasantly pass their time. But can they do so here* 
the question again recurs, with any approach to safety? 

In this connection lies one of the chief excellences of Naples ; 
in that it is possible for those who fear to remain even in the 
comparatively healthy portions of the city during the winter * 
and for all in the summer months , to reside in its immediate 



— 38 — 

neighborhood , so as to visit it every day if they choose , and 
yet at night breathe a pure and refreshing air. Portici , Torre 
del Greco , and Torre dell' Annunziata have but little advantage 
over the lower portions of Naples, being themselves nearly at the 
sea level ; they are merely a little less crowded. At Castellammare, 
however , but an hour away by rail , one can sleep upon the 
mountain side, with an atmosphere almost as bracing and refined 
as at Assisi or Perugia ; and many do indeed make this town 
their head-quarters during their whole residence , so called , at 
Naples. Sorrento is even a still more lovely and healthier place 
where , with a little more fatigue , Naples is still sufficiently 
accessible to visit several times each week. With a steamer across 
the Bay , from Sorrento to Naples every morning , and back at 
night, as does occasionally occur during the summer at the season 
of sea-bathing , nothing can possibly be more convenient, or in 
every way more satisfactory, whether for pleasure or health. 

Upon the other side of Naples, Posilippo and Pozzuoli, whose 
climates are so different, the latter being a place for winter and 
the former for summer , are easily reached ; and even Caserta , 
an hour away on the road to Rome , affords a very enjoyable 
resting-place from whence to study Naples. Further away still , 
to the South, are La Cava, Salerno, and Amalfi , of whose ex- 
ceptional situation mention has already been made; each of them 
valuable as residences in themselves, or as points from which to 
make frequent visits to Naples. The larger Neapolitan islands , 
Capri and Ischia, both of them admirable as places of prolonged 
stay for certain forms of invalidism , are yet not too remote for 
simply sallying points, This is especially the case with Ischia, its 



— 39 — 

daily steamer permitting a return to the island at night ; which 
with Capri , is as yet impossible , and the night must be spent 
in Naples. 

Hereafter, something further may be said upon the respective 
merits of these several sanitaria , all of which are still but too 
little known to foreigners, especially to Americans. 



V. 



Briefly , but still , it is to be hoped, clearly enough , there 
has been sketched in the preceding letters an outline of the reasons 
for and against Southern Italy as a legitimate health station. The 
objections that have been urged to it by others have neither been 
concealed nor underrated, while the arguments in its favor have 
been presented without exaggeration or personal bias. With even 
more emphasis it might have been intimated that , when Naples 
has but once obtained the sufficient water supply that so long- 
has been needed , and now seems to be really within near ac- 
complishment, and has completed the new system of deep water 
drainage , rendered possible by the massive embanked causeway 
now building to Posilippo outside the Ghiaja, it will become with 
justice the great centre of Mediterranean invalid resort, the claims 
of Nice , Algiers , and Catania to the contrary notwithstanding. 
With direct steamers from New York, and the sleeping cars already 
introduced into Italy making the trip by Genoa as well as Bologna, 
there will be no need of such attractions as an eruption of 
Vesuvius, or even the more permanent one of the proposed railway 
up that mountain, to induce strangers to come hither. Not that 
we would deny , even to invalids , an occasional indulgence like 
the trip now referred to , when it shall have become possible. 
Even more than the rail ascent of the Righi and Mount Washington, 
it will have its extraordinary charm , and can be accomplished, 



— 41 — 

no doubt, by the most helpless and feeble with complete safety. 

Until , however , the changes in the sanitary condition of 
Naples that have been already commenced, shall have been real- 
ised, many of its visitors, thoughtful for their own safety , will 
continue to spend a portion of their Southern visit in the imme- 
diate neighborhood of the city rather than within its walls. It 
may, therefore, be for the advantage of those who have thus far 
followed the writer , to devote this letter and a succeeding one, 
the last of the series, to a fuller consideration of the minor health 
resorts surrounding Naples than could have been given to them 
in the more general consideration that has preceded. 

The health suburbs of Naples , including the islands , lie in 
an almost complete circle , not enclosing the city, but extending 
to the right and left, or west and east , with it facing the Gulf 
as a base. These several localities, some ten or twelve in number, 
moreover, form themselves into four distinct natural groups, with 
very different kinds of climate, depending upon their position rel- 
ative to the mountains and the sea. The members of these groups 
may be classified, still again , with reference to the Southern or 
other aspect of each place. 

We have , accordingly , first , the completely inland towns , 
La Cava and Gaserta. 

Gastellammare and Amalfi, each occupying an opposite side of 

the base of the immense Sorrentine Gape, are yet shut off from 

it by a lofty range of mountains ; while between them there is 

so long a distance , and so great consequent modification of the 

winds from the Gulfs of Salerno and Naples , as to throw these 

towns into the second group in our classification — the littoral ; 

6 



— 42 — 

which also includes Posilippo, practically but an outlying quarter 
of Naples , and Pozzuoli , Portici , Torre del Greco , and Torre 
dell' Annunziata on the Northern Gulf , and Vietri and Salerno 
upon the Southern. 

Then, again, Sorrento with its dependencies — Meta , Vico , 
S. ra Agata, and Massa, which together occupy many square miles 
of territory — affords a climate as perfectly peninsular as is the 
promontory itself. 

Fourth , and lastly , comes the insular series , consisting of 
Capri, Procida, and Ischia ; for Ponza, from its comparative re- 
moteness , and from having been devoted by the Government to 
penal purposes, must practically be counted out; Ventotene is also 
too distant ; while Nisida, the smallest of the islands, is too near 
the mainland to escape the severity of its winds, and is, besides, 
the Neapolitan quarantine station. 

Of these localities there are several that, for the present at 
least, are hardly fitted at all seasons of the year for the residence 
of invalids, for the reason that as yet they are not provided with 
sufficiently comfortable hotels. 

The towns of the first and inland group are quiet places , 
but well situated and comparatively clean. To many invalids it 
would be an advantage to stop at Caserta on their way to Naples 
from Rome, and to wait there for a while until they have become 
accustomed to the change to the more Southern climate. It can 
also be reached from the North by the Eastern coast line by the 
way of Ancona and Foggia , the through journey from Bologna 
occupying a little less time in hours than by Florence and Rome; 
and it is, moreover, upon the direct line to Naples from Brindisi. 



There are pleasant walks and drives, and the place is near enough 
to Naples to render the removal thither at any moment an easy 
one. La Cava, upon the other hand, can only be reached through 
the- city itself. Like Salerno, it affords a safe and pleasant resting 
station for those who wish to visit unhealthy Paestum , the trip 
to which from Naples and back again is too fatiguing for an 
invalid to make satisfactorily, as is often tried to be done, in a 
single day; but, unlike Salerno , it is away from the beautiful 
sea. There are those to whom this would be an advantage rather 
than an objection, but to most persons , sick as well as sound, 
provided their hotels are so situated as to avoid the reflection of 
the noonday sun from the waves, the sight of the Mediterranean 
is a constant pleasure. Its shores are not so noisy as those of 
the ocean , for storms are infrequent , and so slight is the tide 
and so salt and dense the water, that when roused to motion it 
again rapidly subsides. La Cava , like Caserta , is replete with 
objects of local interest, and can boast withal of one of the best 
kept inns in Italy. 

The littoral towns, as compared with those now mentioned, 
Will be found both to lose and to gain in hygienic value. There 
is more to interest and to keep the invalid from ennui, but then^ 
again, their shelter is less from the searching Winter winds.. Of 
Salerno , mention has already more than once been made. It is 
the nearest safe point to Paestum ; and its own associations with 
the past are so many and varied , as to make the residence a 
pleasant one to all who are strong enough to move about and 
healthy-minded enough to take an interest in what surrounds 
them. Like Pozzuoli * Posilippo, and Naples itself, Salerno faces 



— 44 — 

south , and thus has a longer and warmer day in winter. And 
so also has Amalfi , with the additional advantage of being a 
smaller place, with but few outside nuisances apart from its mills 
in the immediate neighborhood , and having so far, were it not 
for the filthy stream that runs directly under its principal hotel, 
a purer atmosphere. It is protected , moreover , to the east and 
west by sheltering cliffs, which, besides breaking the winds, serve 
to concentrate and throw down upon the town the sun's reflected 
heat. To the full force of the sirocco it is, to be sure, exposed, 
and unlike Mentone, the walls of rock behind it are channelled 
by the stream above referred to , and its bed permits the town 
to be swept by the Northerly wind. The great objection to Amalfi 
as a place of prolonged residence is that, like Sorrento, it is an 
hour or two away from the rail , and also like it, though even 
more abruptly, at the end of the high road. The feeling of iso- 
lation thus produced , in a little place , sometimes becomes an 
irksome one — enhanced in this instance, perhaps, by the horizon 
being bounded by the open sea , while its neighbor over the 
mountains has in full sight the great city across the bay , and 
ils sea view is surrounded in every direction by an almost unbroken 
wall of islands and the main. 

Yietri, lying between Amalfi and Salerno, to the former of 
which it is the nearest point upon the rail , is a pretty place 
enough, but as yet unprovided with accommodation for invalids, 
or indeed for any strangers. The towns on the eastern shore of 
the upper gulf — Portici, Torre del Greco, and Torre dell'Annun- 
ziata — are of little interest, save for their propinquity to Pompeii, 
which is however reached in so short a time from both Naples 



— 45 — 

and Gastellammare, that to reside in either of the three, so far as 
this reason at least is concerned, is by no means advisable. Upon 
the other hand, there is no place in the vicinity of Naples more 
frequented by strangers during the winter than Castellammare. 
This , however , is owing to its being but an hour away , and 
wholly by rail, from the city. The town itself is an unattractive 
one, with very little in winter to recommend it. In summer it 
is true that many Italians resort to it for its mineral baths — which, 
however, unwarmed artificially, are too cold for delicate persons — 
and for sea-bathing . by no means improved by its vicinity to 
the crowded and dirty harbor ; and there are several quite 
comfortable hotels, charmingly situated high upon the mountain, 
not far from the summer palace of the former king. This is in the 
midst of lovely forests of chestnut and beech, and there are de- 
lightful excursions to be made in every direction ; but in winter 
the winds at Castellammare blow strong , the sun is early hid 
behind the hills , and were it not for a certain reputation for 
comparative cheapness — the difference from Naples however, all 
things considered, being more apparent than real, — and an equally 
doubtful claim for relative healthfulness that it has of late 
acquired , few strangers would probably be found , between the 
months of October and June , to give it a second thought, For 
certain cases of disease, the mineral waters of Castellammare are 
prescribed by Italian physicians ; but they are also to be procured 
in Naples, and can there be drank or bathed in as well as nearer 
their source. As a general rule, it is probably true that mineral 
baths, when the water has to be artificially heated, are not pro^ 
ductive of the same effect as where the springs themselves are 



— 46 — 

hot on emerging from the earth , as is the case at the island of 
Ischia. For this and other reasons it would seem that for a course 
of such treatment, even for the same diseases that are sometimes 
sent to Castellammare, a stay of a few weeks at Ischia is greatly 
to be preferred. 

Of Sorrento, however, though farther away from Naples than 
Castellammare, and with a drive beyond the latter station of an 
hour and a-half by carriage , there is yet much to be said that 
is favorable. One of the third series , its climate is markedly 
peninsular ; but as a winter residence , Sorrento is not to be 
advised. The reasons for this can easily be appreciated. Sorrento 
is situated upon the summit of a lofty cliff, whose edge is swept 
by every gale from the north and west and east ; the town faces 
due north, and the density of the foliage in the orange and lemon 
groves with which it is everywhere crowded is such that the rays 
of the feeble wintry sun can hardly penetrate among them. It is 
above all no place for private house-keeping in winter, for the 
few villas, that are so lovely in summer, are then, overshadowed 
as they are by the evergreen growth, too damp and chilly to be 
lived in even by the well* The hotels, however, of Sorrento, are 
proverbial for their elegance and comfort. There are one or two 
of them , pre-eminently the Tramontane) , that may as safely be 
recommended even by a physician to his patients as its namesake 
upon the Corso Vittorio Emmanuele at Naples. In their southerly 
rooms all the sun that there is caught and , thanks to well- 
fitting sashes, so rare in Italy , its influence is preserved ; while 
even in winter the views both by land and by water are extreme- 
ly beautiful. Whoever has once seen the Sorrentine cliff vistas, 



— 47 — 

but longs for them again , and they ever remain to the mind 
a real presence , yet with all the witchery of an enchanting 
dream. 

While the winters at Sorrento vary, and at times are com- 
paratively harsh, exposed as it is to the full force of every northern 
blast, its summers are delightful. They are cooler than the average 
one of New England, for a day does not pass through the many 
weeks during which there is no rain, without there being several 
hours of delicious sea-breeze , by whose influence vegetation is 
preserved from the otherwise inevitable drought , and even the 
mountains themselves are kept permanently green. There are lovely 
mountain walks and saddle drives in every direction, and though 
there are many who visit Sorrento who find , away from the 
cliff-edge, only a perplexing labyrinth of high stone walls, yet to 
those who have .perseverance enough to climb beyond them there 
opens out an endless succession of as enchanting views of land 
and sea as can well be found in the world. The descriptions of 
its scenery that have been given by some of our country people — 
as by Hillard in his "Six Months in Italy," Mrs. Stowe in 
"Agnes of Sorrento," and Mrs. Julia Ward Howe in "From the 
Oak to the Olive" — though seeming overdrawn and too highly 
colored to those who have never seen for themselves , are ye^ 
strictly within the truth. For invalids , the change to Sorrento 
for a few days or weeks , after the fatigues of the city , or a 
bathing course at Ischia , will often prove of benefit ; to those 
who are well it may be said that if they leave Naples without a 
fortnight , at least , of mountain climbing at Sorrento , they are 
simply doing a very foolish thing. The boating, besides, is good. 



— 48 — 

Within easy distance of the landing place there are several grottos 
worth visiting, while the constant change of light and shade, as 
seen from the sea, upon the perpendicular face of the long miles 
of cliff, affords a pleasurable excitement to those capable of such 
enjoyments, that can never satiate or fatigue. The greatest fault, 
perhaps, that can be urged against Sorrento is the tedious climb 
from the beach and landing to the top of the cliff upon which 
stands the town. This ascent should never be attempted on foot 
by the feeble, for whom, however, there are always donkeys in 
waiting , and portable chairs. Of the pleasures of sea-bathing 
during the season at Sorrento , as compared with that of the 
New England coast , too much cannot be said in praise. There 
is absent the shock that our surf affords , but this is not loss 
but gain , for it can never be safely borne by the delicate , and 
frequently causes injury even to the healthy and strong. The 
sea-water at Sorrento is clean, which is not always the case on 
these Italian shores; it is warm, delightfully so in summer, and 
in great contrast to the constant chill of the sea on the Northern 
Atlantic coast. Even in winter but little added heat is needed to 
enable those whose health may require salt-water baths to enjoy 
this luxury in the comfortable, chambers of their hotel. To those 
who may wish to swim in the open sea, it will be a satisfaction 
to know that, contrary to what might have been supposed, one 
great danger is absent, sharks never approaching this part of the 
shore. During the summer, the sea at Sorrento is thronged with 
bathers, native as well as foreign ; and when it is borne in mind 
that the Italian sailor and fisherman are always excessively timid, 
alike with regard to dangers above and those below , the fact 



— 49 — 

that they constantly venture the farthest and swim the longest 
of all , may safely be taken in proof of the assertion that has 
now been made. The little town is withal tolerably well kept 
and clean. The writer lived eight months among the Sorrentines, 
and he found them always obliging, good-natured, and, as com- 
pared with the people of other places that might be mentioned, 
exceptionally honest and reliable. 

There remain now to be considered , in their relations to 
Naples as accessory health stations , the islands of Capri and 
Ischia — the former of which conveys to many people no other 
idea than that of containing a grotto , and by others is sup- 
posed, however unjustly, relinquished to habits of social life not 
unlike those that characterised it in ancient times; while to the 
hot springs of Ischia, so renowned in those older days as waters 
of healing , scores of chronic cases , many of which have been 
pronounced hopeless, annually resort from the most distant lands 
and are cured. 

To these interesting islands will accordingly be devoted the 
next and concluding letter. 



7 



VI. 



Five letters upon the merits and demerits of Naples and its 
environs as a health station have now been published. In these 
communications the Italian climate in its relations to foreigners 
and its alleged effect in occasioning or predisposing to febrile 
disease, as well as its beneficial influence upon certain forms of 
invalidism, have been carefully considered ; while the situation , 
characteristics, and sanitary condition of the Southern capital have 
been discussed, and compared with corresponding features of other 
great continental centres of travel. In addition to this, due at- 
tention has been given to three of the four groups into which 
the subordinate outlying and neighboring health resorts upon the 
Neapolitan gulf naturally divide themselves — to wit, the wholly 
inland , littoral and peninsular ; the last of these including that 
favorite resort of Americans, whether sick or well — Sorrento. 

There now remain for consideration the concluding or insular 
group of these secondary invalid stations, composed more especially 
of Capri and Ischia — comparatively the largest of the Neapolitan 
islands, and the only ones, as has already been remarked, as yet 
provided with accommodations for foreigners. To a statement of 
the distinctive features, hygienic and curative, of these localities, 
the present letter will therefore be devoted. With it is completed 
our brief summary of what may justly be hoped for, expected and 
sought, as well as feared and avoided, by invalids in Southern Italy. 



Of Capri, it is exceedingly difficult to speak in the measured 
and unenthusiastic terms alone appropriate to the writer's present 
purpose. The place is so different from all others, its characteristics 
are all so special — its outline , the material even of which the 
island is composed, its people and their ways — its foreign colony, 
so completely artistic in tastes and life — its history, and indeed 
its very atmosphere — that the traveller, who beforehand knows 
aught of its actual features , looks forward to the visit with an 
interest that can scarcely fail to be realised. Not one of a hundred, 
however, of those who annually reach Capri ever goes above its 
landing , for it is not for the interest of the steamboat officials 
to tell of attractions that might lose to them the tourist's return 
ticket to Naples — the chance being that, if once caught by the 
charms of the place , he would elect to remain , and afterwards 
cross to Sorrento, or Ischia by row-boat or sail ; but of the very 
small number of visitors who do decide to spend some days or 
even weeks upon the island, if any are found to express disap- 
pointment at having done so, it may safely be said that the fault 
has been with the individual and not with Capri. 

In sanitary respects, or rather as a curative health station, 
Capri differs from Sorrento fully as much as the latter differs 
from Castellammare or even from Naples. Sorrento and Naples 
rest upon volcanic soil, while Capri is formed, like the Sorrentine 
boundary cliffs at Meta and Massa, of limestone rock. The tufa 
of Naples and Sorrento , though in summer superficially dry, is 
yet , from the very fact of being so porous , apt in wet seasons 
to become saturated with moisture , so as to act as a damp 
foundation or background ; whereas at Capri the rainfall is directly 



— 52 — 

shed into the sea, and whatever moisture the air may contain is 
therefore the effect of the healthful sea breeze, and not of evapo- 
ration from dark and shaded gardens into which the sun finds 
it very hard to penetrate. At Sorrento, moreover, healthy as it 
is compared with many places , the soil is very rich and very 
deep , the farmers are thrifty and care more for the welfare of 
their trees and market stuff than for that of the strangers who 
come among them , fertilizers of not the cleanliest character are 
largely and very carelessly used , and the odors that everywhere 
arise at nightfall and during the descent of rain are not those 
only of lemon and orange blossoms. At Capri, on the other hand, 
the heath and myrtle and laurel , the aloe and the prickly pear 
not merely characterise a different soil and vegetation , but they 
prove a wholly different local climate. The seasons in which to 
reside at Sorrento are preeminently the late spring and summer, 
for the well , and for the invalid also ; while Capri , though as 
charming as Sorrento during the rainless season , is found to 
afford, more than the other, safe and sunny points for residence 
during the winter months. Provided as it is with quite comfortable 
hotels, it is only strange, and certainly to be regretted, that the 
great tide of travel now floats by its base , resting merely for 
one short hour at the cave under its cliff, and then the average 
tourist returns again, knowing absolutely nothing whatever of the 
island or its true and best attractions. To speak more fully of 
the grotto hardly comes within the physician's province , though 
he may justly state that while visiting it one cannot be too careful 
against becoming chilled , for the change from hot sunshine to 
its shades is sometimes very great. Having said this , it may 



— 53 - 

perhaps be added that, while great disappointment is often felt 
by those who are seeing it for the first time, this feeling is quite 
sure to be changed to delight upon a second visit or a still 
subsequently repeated return. 

The air of Capri is somewhat exhilarating, even in weather 
that would be depressing elsewhere ; more so than that of Ana- 
capri, the cliff town at the westerly extremity of the island, for 
this latter is veritably situated up in the clouds, and is therefore 
frequently shrouded more or less completely in an atmosphere of 
mist. An English physician of deservedly general repute in sani- 
tary matters had expressed to the writer his belief that Anacapri 
was better situated for invalids , particularly if of consumptive 
tendencies, than the village of Capri itself, but this view has 
proved an erroneous one. The great and only attraction special 
to Anacapri that it has hitherto possessed, has been its inacces- 
sibility and the consequently peculiar character of its inhabitants, 
resulting from their practical isolation from the rest of the world. 
Now, however, that the quite comfortable carriage road has been 
completed to the very summit of the upper plain, it becomes but 
a portion of the town below, loses its distinctive fascination and, 
for health purposes, while desirable enough as the limit of a 
pleasant hour's drive, cannot compare with the lower crest line, 
upon which stand that most interesting and comfortable old 
convent hotel, the Tiberio, and the more modern Quisisana. 

Passing to Ischia, we find an island very different in every 
respect from Capri. There is not merely greater space, with' a 
variety of excursions upon high road and bridle path that would 
require several weeks instead of days to exhaust, but there is an 



individuality of its own as interesting and as satisfying as that 
of Capri, and of infinitely more importance to many great classes 
of invalids. Unlike Capri, Ischia is volcanic, and there have been 
very active eruptions within historical times. It has the insular 
climate of Capri, and even more tropical vegetation, and, besides, 
it is studded from one end to the other with powerful medicinal 
springs, the temperature of some of which approaches the boiling 
point. The most noted of these are at the village of Casamicciola, 
which lies high upon the mountain side, and yet is protected by 
flanking hills from all harsh winds. For these reasons it has 
become a noted resort for delicate persons of both sexes and all 
ages , and of many nationalities. The fame of these springs has 
come down from the remotest antiquity, and it is only remarkable 
that while they are of such repute among the physicians of cer- 
tain countries , as Germany and Russia for instance , so little 
seems to be known about them by English and Americans. They 
are briefly mentioned by one or two of the leading hand-books 
of travel , but Appleton ignores them entirely , and Bradshaw , 
though acknowledging their value in the page or two upon islands 
at the end of his "Guide," yet wholly omits all mention of Ischia 
in the Table so constantly consulted by the invalid traveller , of 
skeleton through-routes from London to the principal baths and 
watering-places of Europe. As yet, though much has been written 
by Italian practitioners upon several of the Ischian springs, there 
is lacking a comprehensive and authoritative manual of these 
waters that would be useful to sick persons and their medical 
advisers. The nearest approach to what is required seems to have 
been made by the late Chevalley De Rivaz, a Swiss physician long 



— 55 — 

resident at Gasamicciola , but this work , which was published 
only in French and Italian , saw its last edition in 1 859 , and 
has long been so completely out of print that it is now almost 
impossible to obtain a copy. 

The bathing establishments of Gasamicciola are several in 
number, and vary in their degree of commodiousness and comfort. 
Two of them , however , for the completeness and even elegance 
of their appointments, may well challenge comparison with any- 
thing that can be found at bathing stations that are far more 
widely known. Not only are these waters bathed in, drank, and 
otherwise used internally ; they are also employed as a hot paste 
with clay, for long-continued external application, thus combining 
the effect of the "earth dressing," of late prominently brought 
forward by Dr. Hewson , of Philadelphia , with the additional 
influence exerted by the mineral salts that the waters contain. 
Still another method has suggested itself to the writer, and he 
has already tested it with favorable results in quite a number of 
cases ; applied to the skin in an emulsion with suitable vegetable 
oils, the waters exert a marked and rapid action towards impro- 
ving the nutrition of feeble persons and their general constitutional 
condition — realising even more completely than had hitherto been 
possible , the indications made by the late Sir James Simpson , 
of Edinburgh, in his monograph upon oil inunction in the treat- 
ment of consumptive and other scrofulous invalids. Beside the 
thermal springs , there exist at Ischia outlets of hot vapor from 
the same volcanic source , and these have also been utilised for 
medicinal purposes. The air in some of these "stufe," as they 
are called , is almost perfectly dry , while in others it is moist, 



— 56 — 

and they afford to those invalids who may require them , the 
choice of a Turkish or Russian bath, of nature's own providing. 

It would be far from scientific, and indeed extremely irra- 
tional, to believe that a panacea can ever be found, or any agent 
or drug capable of more than a comparatively limited application 
in the treatment of the manifold forms of human disease. So 
great, however, is the variety of the Ischian springs, differing as 
they do so materially among themselves , even when situated 
within a few feet of each other , in their mineral constituents , 
their temperature , and the effect that they produce upon the 
normal, as well as the unhealthy system, that one might almost 
accept without question the statement made to the writer by a 
Swiss gentleman, who, having two years previously had the use 
of a limb restored by these waters , was undergoing a second 
season's course as a preventive against a return of the malady. 
"If there exists a disease," he said, " that cannot be cured by 
one or another of the waters of this island, when properly pre- 
scribed and made use of, it must be a disorder that can never 
be cured at all." Like all other agents, however, that are potent 
for good, these waters have effected a great deal of harm when 
ignorantly or carelessly employed. It is easy enough in these days 
of popularising science, medical as well as all other, for a patient 
to imagine that all that is necessary to obtain the full benefit 
of a course of mineral waters is to drink them, or bathe, at such 
times, or in such measure, as the whim of the moment may 
approve , and thereby save all trouble of a consultation , and 
withal the physician's fee. Whether it be true or not that the 
lawyer who pleads his own cause is apt to have an unwise client, 



— 57 — 

and still more that even the most skilful medical man when ill 
cannot safely conduct his own case , it is very certain that at 
Ischia instances are constantly occurring where lay persons — who 
have heard that the waters work wonders in this or that disease, 
or that some one of their friends or acquaintance, with symptoms 
that they think the same with their own, has been benefitted by 
their use, — by undertaking to treat themselves , make a great 
deal of unnecessary work for physicians to attend to, A marked 
case of the evil that may result under such circumstances came 
under the writer's own observation , and he therefore feels con- 
strained to speak as fully upon this point , and as plainly , as 
he has now done. 

It will naturally be asked for what classes of invalidism 
these waters are best adapted, and though the present is neither 
the time nor the place to go minutely into such details, it may, 
nevertheless, be said that like all other medicinal springs of any 
real value, those of Ischia are better suited for chronic than for 
acute cases , and that however hopeless such an one may have 
been pronounced, the mere length of duration of the disease proves 
not a necessary bar to recovery. Affections of the bones and joints, 
no matter how occasioned, or how great the consequent deformity, 
often yield as if by magic; longstanding, and inveterate discharges 
are dried up , and unnatural channels closed , and local en- 
largements involving the internal organs are found to diminish 
and disappear. Without indicating more particularly the long list 
of maladies affecting both sexes , that might be mentioned as 
often relieved, there is reason to believe that the repute Ischia 
long ago enjoyed as especially helpful to invalid women was 

8 



— 58 — 

well founded, and that besides the special disorders then recogni- 
sed, in the infancy as it were of this department of the profession, 
there are others , some of them most intractable and ordinarily 
thought hopeless, which nature thus assisted might prove herself 
able to check, and perhaps to entirely remove. At least such is 
the writer's impression , after visits to Ischia in three successive 
seasons, and as careful a study of the effects of the waters , and 
of their medical history down to the present period , as he has 
yet been able to make. 

Apart from these considerations, Ischia has much to commend 
it to those who simply are seeking mental and physical rest. At 
Casamicciola there are good hotels that have long enjoyed a 
deserved reputation among travellers — the beauty of their situa- 
tion and its healthfulness combining to render them attractive. Too 
far from Naples to allow the city's excitements easily to reach it, 
and yet near enough to prevent too great a feeling of distance , 
Ischia combines, far more than centres of invalid resort infinitely 
more pretentious in their claims, the real and substantial elements 
that should go to make up the model sanitorium — good air , 
good food, charming scenery, a quaint and very interesting people, 
special hygienic advantages that to an equal extent can hardly 
be found elsewhere , and , perhaps above and beyond all else , 
for this is seldom true of such places , it can be visited with 
benefit by invalids at all seasons of the year. The waters spring 
hot from deep in the earth, the nature of the soil and surroun- 
ding rock rendering them less liable to be affected by rain or 
drought , or the ordinary atmospheric influences , so that the 
common belief, held even by some physicians, that mineral baths 



— 59 — 

are beneficial only in summer, seems here to fail of its force. It 
is true that in summer Casamicciola is occasionally somewhat 
crowded, naturally more so than during the rest of the year ; 
but in spring, and in autumn, and in winter, the waters are 
as hot and as strong , there is equally good accomodation for 
strangers, and the winter climate of the island is milder and 
more enjoyable than perhaps any other in Europe. 

And here, these letters may properly close, the reader having 
been brought step by step through Southern Italy to the place 
of all others which the writer has found , in his own instance 
at least , to give the best promise of restoration to health , in 
whole or in part, to those seeking this greatest of blessings. 



The following extracts from a Report upon European Winter Cures 
made by the writer, as Chairman of a special Committee upon the subject, 
to the American Medical Association in the spring of 1875, will be found 
perhaps important in connection with what has preceded. 



In a series of letters hitherto published, the writer has spoken 
of the frequency of fever in Southern Italy as compared with 
other portions of this country, and our own, and has expressed 
the opinion that not only is the number of cases, whether ma- 
larial or enteric, greatly exaggerated, but that of those actually 
occurring a very large proportion are the effect of carelessness 
upon the part of the traveller. Over-exertion in the way of 
sight-seeing, especially if continuous, as is very frequent here, — pro- 
longed exposure to the sun, — indulgence in as gross and heating 
a diet as might be necessary at the North, — to live even for a 
single day in hotels whose atmosphere is redolent with the efflu- 
via of ill-aranged or defective drains , may be mentioned as 
instances in point. In addition to these , there exist the general 
causes already numerated, but they are yearly being lessened. 

Should it be questioned concerning the writer's statement 
as to the present health condition of Naples, even at its worst, 
he hereby gives the exact figures that represent the mortality 
among Americans at Naples and within the whole Southern 
provinces for the last six years. They are kindly furnished for this 
purpose by the United States Consul, B. 0. Duncan, Esq. 

In 4 870, there were in Naples two American deaths, one of 
which was the result of an incurable chronic disease, and the other 
from fever; and there was one death, from consumption, at Sorrento. 



— 61 — 

In 1 871 , there were two deaths in Naples ; one of them an 
infant within the first three weeks, and the other a sailor, wound- 
ed in a brawl. 

In 1872, there was one death at Naples, from consumption, 
— the day after arrival by sea, the patient being in a dying 
condition before entering the gulf, — and there was one death 
at La Cava, the result of long continued intemperance. 

In 1873, the cholera year, there were eight deaths in Naples, 
three of them being from cholera ; and of these three, two were 
sailors, and the third a circus-rider. Of the remaining five deaths, 
one was from fever, — one, a child, from whooping cough, — 
one, from chronic paralysis, — one from consumption , the case 
being brought here from Egypt, — and the eighth, a sailor, from 
disease unknown. During this year there was one death at Amalfi, 
from fever; and another, also from fever, at Capri, — the disease 
having been brought from Rome. 

In 1 874 there were three deaths in Naples , all of them 
sailors on vessels of war , of fever contracted in Asia Minor. 
There was one death at Sorrento , of fever , and one at Castel- 
lammare, from heart disease. 

In 1875, up to the present date, early in April , the tra- 
velling season having almost ended , there has been one single 
death , of fever ; the subject having been an eccentric person , 
accustomed to take his out-door exercise late in the night. [There 
was subsequently , during the same month , another death at 
Naples , in a convulsive attack or fit , consequent upon disease 
of several years duration; and a third, at sea, upon the pas- 
sage to Ischia, the result of an equally chronic affection.] 



— 62 — 

Upon recurring to these tables it will be found, after elim- 
inating the three Asiatic cases of fever, that of the many hundreds 
of American travellers who have visited Naples during these six 
years, many of them coming here invalids enfeebled by chronic 
disease, and many others arriving in a febrile condition , — having 
been taken ill at home, or upon the journey, — only five persons 
have died in Naples and the whole surrounding country , of fe- 
ver, — whether typhoid or malarial, — the average being less than 
one each year ; a result that will prove surprising to those who 
have been accustomed to hear the rumors that have been an- 
nually set afloat , or indeed to imagine that the risks to life 
from fever are here much greater than at home. 

The Riviera, beyond which some persons cannot, and many 
dare not go , is by no means , in any of its several stations , 
absolutely well fitted for severe instances of invalidism. With us 
Americans the case is a very different one than with the English, 
whose permanent homes are comparatively so near at hand. They 
naturally start to return to them on the first intimation of spring, 
too often finding in the great change of temperature awaiting 
them at Paris or London a fatal attack of acute pulmonary disease; 
while for our own people to make this so early northern 
transit has no excuse save that of fashion , and the fact that to 
remain beyond a certain period upon the Riviera is said to 
involve an intolerable degree of heat , and the dangers thereto 
pertaining. 

What has been really wanted — or so it seems to the writer — 
for the American invalid in Europe, is a climate more continuously 
equable — not merely so for a few weeks , and in comparison 



— 63 — 

with that of Paris or London — but where one can stay for month 
after month if necessary, without there being involved the great 
fatigues of travelling , a compulsory change of quarters , or the 
cutting short , at a fixed and stated period , of steady progress 
and grateful rest. 

What has here been indicated is impossible upon the Riviera; 
it is impossible at any of the more northern or summer health 
stations, and, to come further south, it is practically impossible 
at Milan or Florence, Venice or Pisa, Genoa, Bologna, Lucca, 
or Rome. It exists at neither of the more distant Mediterranean 
stations at Algiers, Malta, Palermo or Catania, Athens, Constan- 
tinople or Cairo ; for, although Egypt has so much to recommend 
it for a few weeks during winter , it can hardly be advised as 
the place for a really prolonged residence, or for a shorter stay 
at any and every season of the year. At Naples alone — so far, 
at least, as the writer's observation has as yet carried him — and 
in its immediate neighborhood , are the necessary conditions for 
such protracted or frequently-repeated residence, with any degree 
of safety, fulfilled. 

And here let it be mentioned that , although previously fam- 
iliar with Naples, the present visit to it was made with exceed- 
ing dread. In Dr. Bennet's interesting work it is almost laid down 
as an axiom, that whoever sees Naples must necessarily soon die. 
A careful study, however, of the premises for a year and a half 
(now two years), of the medical history of the city, and of the 
causes which have conspired to give it its ill name, has gone far 
to dispel any such belief, and even to substitute a very differ- 
ent one. 



— 64 — 

"To the invalid," says Dr. Bennet, "Naples should be abso- 
lutely forbidden." (1) 

Upon the other hand , remarks Dr. Cox , also of London : 
"When the autumnal rains fall, and the sun has less power, the 
invalid should remove into Naples, which is at that season equal, 
if not superior, as a place of resort, to any other in Europe." (2) 

There is here perceived the flattest contradiction , not to be 
explained wholly by the fact that one of the authors now quoted 
had made his winter residence and professional field of labor in 
Southern Italy, while the other has for a long period been iden- 
tified with the Riviera, — for both of them were, undoubtedly, 
actuated by a higher than personal motive. We must the rather 
conclude, as so often happens in such cases, that both were right 
to a certain extent, and both were wrong. Dr. Cox , and again 
Dr. Bennet , used the term invalid in altogether too general a 
sense, and, besides, there are other points underlying the state- 
ments of each, of equal and very great importance. In explaining 
this discrepancy of opinion , the writer will , at the same time , 
have expressed his own views as to the circumstances under 
which the Bay of Naples may be considered as a safe and advi- 
sable invalid resort. 

The usual prefatory remarks that have been made by writers 
upon the health of Naples, as to its latitude and longitude , its 
population and the habits of its people, may be left to the 

(1) J. Henry Bennet. "Winter and Spring on the Shores of the Medi- 
terranean." London, John Churchill and Sons. 4870, p. 243. 

(2) J. C. Cox. u Hints for Invalids about to visit Naples." London, 
Longmans and Co. 1841. p. 187. 



— 65 — 

guide-books. It is enough to say that, speaking of the city, and 
not of its suburbs, there is an old town and a new : the former 
closely packed , filthy in every sense, greatly shaded in winter , 
and exposed to harsh winds ; while the latter is comparatively 
sheltered, well-kept and sunny, and, what is of vast moment in 
this consideration , it is improving from year to year. Of the 
latter locality alone are we to speak. The contrast between the 
two is nearly as great as between new and old Paris. Here , 
however, as there, new boulevards are being constructed through 
the old city, and there is no good reason why eventually , after 
a proper water supply shall have been established , even the 
foulest quarters of ancient Naples should not be made passably 
clean. 

That the Neapolitans themselves should delight in the beau- 
tiful situation of their city , and commend its innumerable at- 
tractions, classic and present, is not to be wondered at ; but we 
find the same spirit pervading its medical men, who, in publica- 
tions intended for the eye of the profession alone, would be quite 
sure to state its faults as freely as its excellencies. As an instance, 
take the following quotation from a work by Dr. Salvatore De 
Renzi, who, for many years, was one of the chief physicians of 
Naples: "The temperature of our climate," he says, "the purity 
of its air , the variety and profusion of food , and innumerable 
other favorable circumstances, unite in rendering Naples extremely 
healthy as a place of residence. This is proved by the experience 
of all who are only attentive and obedient to the laws of health." ( 4) 

(I) De Renzi. u Topografia e Statistics Medica della Gitta di Napoli." 
Naples, 1857, p. 322. 

9 



— 66 — 

Now, if but the two first of these essentials be granted — name- 
ly , a mild and equable temperature and a pure and constantly 
changing atmosphere — a great part of the illusions ordinarily 
held as to the necessary unhealthiness of Naples will be found to 
be dispelled ; while let the last item — obedience to the laws of 
health — be but passably rendered, and the foreigner need scarcely 
dread his brief period of acclimation. 

As is generally known , the portion of Naples ordinarily 
inhabited by strangers is the lower part of the new city , that 
called the "Chiaja." Here are the greater portion of the hotels 
and boarding-houses; in close vicinity are the most noted shops, 
and the bankers to whom strangers are most frequently accredi- 
ted ; here the fashionable drive and promenade ; and here, too, 
that most fascinating and, in this case, most deadly attraction, 
the shore of the beautiful sea, always very lovely, but here, even 
in weather that necessarily keeps one within doors , a constant 
source of enjoyment to all whose position commands its sight , 
because of its superb surf during the sirocco, equalling in grandeur 
that of the Atlantic. 

To this place the strangers come, and here it is, in a certain 
proportion of cases , that they are smitten by the influence that 
sooner or later may bring them to death. 

Knowing this, and having himself twice been made ill here, 
Dr. Bennet warns all invalids against coming to Naples ; ignoring 
the fact that higher up, on the mountain side above, where the 
air is drier and more sweet, and the views infinitely more grand, 
there is a newer quarter still , comparatively unexposed to the 
dangers Ajvbich, till now, have existed in modern and ancient Naples. 



— 67 — 

In the Chiaja quarter, all who have the wit to do so, no- 
tably the old residents, chiefly foreign, hotel and shop keepers, 
and medical men, who make their living from the annual flights 
of strangers, dwell at the very top of their houses, in what would 
elsewhere be termed garrets. This is done not for cheapness, nor 
for the more beautiful view , but for safety. The street-drains 
are everywhere untrapped and open ; they discharge upon the 
shore, in slackwater or but little below it. The nearer one lives 
to the sea, so becomes the air more deadly ; especially at night, 
and in certain winds the most frightful effluvia are forced back 
and high up into the stateliest houses. There are millions of francs 
invested in the hotels and pensions of this same quarter, call it 
by its general term of Chiaja, or its separate names Santa Lucia, 
Chiatamone , Vittoria , and Villa Reale ; but this is of trifling 
importance in comparison with the existing risks to human life. 
One of two things must inevitably happen, viz. : either the pro- 
perty owners of the Chiaja must unite in persuading the municipal 
authorities to entirely renew the whole system of drains, trap them 
and extend them out into deeper water, or else the hotel keepers 
will themselves have to remove to the newer and upper quarter 
of which mention has been made — that of the Corso Vittorio 
Emmanuele. In this new quarter one excellent hotel has already 
been opened ; and another, which promises to become one of the 
largest in all Italy , is rapidly approaching completion , and will 
indeed be in part available for the approaching winter. 

The quarter now spoken of , known best by its main 
thoroughfare , the Corso of the same name , is far above the 
sea, and thus escapes the great dampness and foul odors at times 



— 68 — 

perceived below. Portions of it are sheltered by the mountain- 
side behind from the frequent and fierce North wind , from the 
East, — here the coldest, in consequence of the relative nearness 
of the occasionally snow-covered Appennines, — and from the West 
wind also. Thus there is formed , for a limited portion of this 
quarter, a peculiarly favored shelter, greatly resembling that of 
Mentone; and here, during a large portion of the winter, invalids 
even with the tubercular diathesis are enabled daily to take pro- 
longed and pleasureable exercise in the open air. It is safe to 
predict that within the next ten years, after more buildings shall 
have been erected , and professional as well as other attention 
drawn to this part of the city, it will become not merely the 
favorite winter residence of invalid Americans who happen to be 
in Naples, but of invalid Americans from all Europe. At any rate, 
it fulfils the essentials that were quoted from Dr. De Renzi ; as 
to a temperate climate , being exposed due south , and sheltered 
from every other wind; as to a pure atmosphere, being far above 
the stenches of the town below , to all the attractions of which 
it is still by broad and easy boulevards sufficiently accessible ; 
and as to perfect ventilation , the buildings thus far made and 
to be erected being disjointed from each other, intended as they 
are for the dwellings of wealthy proprietors — and they are indeed 
better deserving the title of palaces than most of the so styled 
buildings of older Naples. 

When speaking of Naples as safe for residence , brief or 
prolonged , it will be understood that the writer refers only to 
the western portion of the quarter Vittorio Emmanuele, for here 
alone, does he believe that nights can without risk be spent. In the 



— 69 — 

day one can descend with almost perfect impunity into the city 
below, for then it is possible to be upon guard; and besides, the 
sun's influence, even when clouded, is potent for good, — but at 
night, he who is wise sleeps only above. An upper story below, 
even in the best appointed hotel, will hardly suffice ; for excellent 
tables and obliging landlords cannot amend for bad street drains. 

It must not be supposed that more than comparative immu- 
nity from illness is claimed for the quarter now spoken of, for 
absolute security is found nowhere in the world. While this final 
page is passing through the press, the writer has under obser- 
vation high upon the mountain side a mild febrile case, the attack 
having originated however, there is reason to believe, outside of 
Naples. Where a predisposition to malarial disease is present , 
from once having been subject to intermittent or remittent fever 
at home, there always exists a liability to its recurrence especially 
if, as in the instance referred to, the individual is already feeble 
and has been bereft through other causes then that now indicated, 
of recuperative power and reserve vital force. In such a case 
typhoidal complication might readily supervene should it prove , 
that the house taken for residence has had a defective trap to a 
closet drain. 

So far for Naples which, outside of sanitary conditions, affords 
more of interest , all things considered , than perhaps any other 
city in Europe. 

In speaking of Ischia, it might have been added that to use 
its waters with advantage it is not absolutely necessary to visit 
the island, though of course to do so is much better when pos- 
sible. There are some invalids however, to whom the idea of the 



— 70 — 

three hours sea voyage becomes an insurmountable obstacle. By 
such , baths can be taken and the waters drank in Naples; and 
indeed , if well bottled , they bear transportation easily , retain 
their purity for a long period , and are well worth sending for 
from far distant places in Europe, and even from America. Their 
general character, though differing among themselves, is strongly 
alkaline. They contain especially the salts of soda, lime and mag- 
nesia, and their temperature upon emerging from the earth ranges 
from 90 deg. to 178 deg. Fahrenheit. With the exception of the 
work of the late Ghev. De Rivaz, (I) scarcely anything of value — 
unless by Andria, (2) and the analyses of Profs. Cossola, Govelli, 
Guarini and Lancelotti — seems to have been written about them 
by residents here or Italians , save in pamphlet form , since the 
days of Jasolino, (3) whose admirable book was published in 1588. 

Regarding the Solfatara at Pozzuoli, which has been recom- 
mended as a residence for certain classes of invalids , the Nea- 
politan physicians are of opinion — and the question is one worth 
considering — that the arsenical and other emanations given out 
by the still smoking crater, sensibly and beneficially modify the 
neighboring atmosphere in a medicinal way, (4) and indeed the 
same view has been held , in the case of the city of Naples , 
concerning the comparatively distant Vesuvius. 

(1) De Rivaz. " Description des Eaux Minero-Thermales et des Etuves 
de File d'Iscliia." Naples, 1859. 

(2) Nicola Andria. "Trattato delle Acque Minerali." Naples, 1783. 

(3) Giulio Jasolino. "De Rimedj Naturali che sono nell'isola di Pitecu- 
sa, oggi detta Iscliia." Naples, 1588. 

(4) Prof. De Luca. "Ricerche Sperimentali su la Solfatara di Pozzuoli. " 
Naples, 1874, p. 13. 



Mess" Pf SSI k Gi's list 

of 

HOTELS, HOUSES OE BUSINESS I C. 

i n 




MAISON DE CONVALESCENCE 

Villa Ropolo. Salita Cappuccini 

TORRE DEL GRECO 

( near Naples ) 

Situated on the side of Vesuvius, with a fine view of the Bay, on the 
route to Pompeii, Castellammare and Sorrento and in the immediate vi- 
cinity of the new crater of 1861. 

Large and small apartments, comfortably furnished, with public parlor, 
baths and promenades. House accessible to carriages and near the Post and 
Telegraph Office. Air balsamic and peculiarly suited to many forms of in- 
validism. 

Pension from 7 to 12 francs per day. 

At the time of writing my book upon Southern Italy as a Health Sta- 
tion for Invalids, I had not visited the Villa Ropolo. Having now done so 
( 17 January 1876 ) I have been favorably impressed by its situation, its 
internal arrangements and the parties having it in charge. 

H. R. S. 



AMODIO 



3. S. Caterina a Chiaia 3. 
NAPLES 

The finest copies of the Classic bronzes of Pompeii & Herculaneum and the best photographs 
of Naples and vicinity. 

M r Amodio has had facilities for copying from the (M-d'oeuvres of the unrivalled bronze 
statues and statuettes from Pompeii & Herculaneum, which are now in the Museum at Naples; and 
the many specimens purchased from him fur public museums and private collections, in Europe & 
America, attest the artistic excellence of the bronzes from his ateliers. 
Terra Cotta Statuettes, Paintings & avast variety of Photographs of the first quality. 

r F, G. PALME 

DEALER 
in China, Glass, Porcelain and English Earthenware. 

PETROLEUM AND OIL LAMPS. 
DEPOT OF AMERICAN PETROLEUM. 
N.° 4. Largo Garofalo 
NAPLES. 

BRITISH CIRCULATING LIBRARY & READING ROOMS* 

NAPLES 

267. Riviera di Chiaia, 267. 
(Opposite the Villa Nazionale) 

The Reading Rooms are furnished with 

English, American & French Newspapers, & various Periodicals. 

DES, ROBES & CONFECTIONS 

I> E3 PARIS 

tt&uott u at ceo & Cf 

G. AVOLIO SUCOESSEUR 



Chapeaiix Coiffures Plumes Confections Eloffes Dentelles 

Fleurs fines Eventails 

Appartement 30 Piazza dei Martiri, palazzo Calabritto. 

Magasins via S. Caterina a Chiaia 8 & 9 
NAPLES. 



PONS SEN & CO. 

IV A L, E S 



MERCHANTS AND FOREIGN AGENTS 

Palazzo Calabritto 38. Strada S. Caterina a Chiaia 



DEPOT of bronzes, coral, lava, tortoise shell, Pompeian jewellery, 
Capodimonte porcelain, Abruzzi ware, photographs, paintings, engravings, 
and all kinds of antiquities. 

Ancient and mediaeval coins, medals and books upon numismatics. 

HOUSE AGENTS WINE MERCHANTS 

Villas, Apartments, Couriers and Sherry, Port, Marsala & other Wines, 
Servants procured. Brandies, Whiskeys &c. 

Travellers' necessities supplied & purchases made on Commission 

Luggage , Parcels , etc. received , cleared at custom house, stored 
and forwarded. Passages engaged for Great Britain, North and South Amer- 
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cepted. 

EMIGRATION AGENTS FOR CALIFORNIA & THE SOUTHERN UNITED STATES 

Commissions executed for grains, oil, fruit, wine, maccaroni, wool, 
hemp, rags, raw silk, cotton, seeds, cork, madder, liquorice, crude tartar, 
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Ischian straw goods, Koman scarfs, pearls and mosaics, Carrara and colour- 
ed marbles and statuary, Florentine mosaics and picture frames, Venetian 
glass and gold chain, Genoese filagree, Sorrento silks and inlaid wood, Neapol- 
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Confidential business attended to in any part of Italy and at aU ports 
of the Mediterranean. 

A Register kept of the Names and Addresses of all Visitors to Naples. 

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ANCHOR LINE 

FORTNIGHTLY SAILINGS BETWEEN NAPLES & NEW-YORK 
CUNARD LINE 

Weekly sailings between Naples & Liverpool in connection with the Atlantic lines to 

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Goods taken by the above companies for Philadelphia, Chicago, etc. at through rates. 

The undersigned having made arrangements with the agents of the above Companies 
are prepared to book goods at moderate rates. 

PONSSEN & Co. 

Commission & Marine Insurance Agents 

38. Strada S. Caterina a Chiaia 
NAPLES 



THE ONLY ENGLISH PHARMACY IN NAPLES 

Established 1826 

KERNOfS ENGLISH PHARMACY 

CHEMIST TO HIS MAJESTY THE KING OF ITALY 

14. Strada S. Carlo — NAPLES 
opposite the Theatre royal. 

Prescriptions & family recipes 
accurately prepared. 

Genuine patent medicines, 
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D r ATKINSON 

Surgeon Dentist 

To the Hospital of the Incu- 
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Royal University of Naples. 

48. Largo S. Ferdinando 
NAPLES 



IHii liHlI. ENGLISH BOOKSELLER 

Libreria Nuova 

NAPLES 140. Via Roma (formerly Toledo) 

Large Stock of Handbooks for Travellers by Murray, Baedeker, 
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Tauchnitz's and Asher's Collections 
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Special Guides, Maps, Dictionaries, Dialogue Books in all Languages. 



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TAIL O Ft 

Piazza dei Martiri N° 52 & 53. 



P. SALES & CO. GENNARO M1GLI0RAT0 

HOSIERY WAREHOUSE Toledo 273 - NAPLES 

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NAPLES 



for the use of Architects. Speciality: Varnish in 
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'or the prevention i craelty k 

SOCIETA ZOOFILA NAPOLETANA 

Honorary President, H. R. H. the Duke of Aosta 
President, Count Alfred de Montfort Laurito. 
Office 45. Strada Pace. 



This Society has been lately established in Naples. 
Contributions will be thankfully received. Every information 
respecting the Society may be obtained on application to 
the Secretary. 



Ok PATJTASSO 

SUCCESSOR TO CIRIO & CO. 

e^tcs-iljIsh: g-bocee 

54. Largo S. Ferdinamlo 

NAPLES 

Native & Foreign Preserves & Canned Goods , Potted 
Meats, Cheese, Wines & Liquors 
Maccaroni, &c, dried Fruits & Vegetables, for Exportation 



ROME 

FATE ENGLISH BOARDING HOUSE 

beautifully situated on the 
Southern part of 

Piazza di Spagna No. 9, 2 lld floor. 
Kept by A. BARBIELLINI. 



189 E HAARDT 189 

Via Roma Via Roma 



Linen ready made & to order for Ladies & Gentlemen 

Shirts accurately fitted to measure 
English, French & German spoken. 



174 A. RADICE'S 174 j PHOTOGRAPHIC ESTABLISHMENT 

Via Roma SUCCESSORS Via Roma of 

A. tl E 

Piazza dei Martiri 

Ground floor (Entrance through the Garden) 

and 

Strada Pace No. 7. 
NAPLES 

Speciaiily for Children. 



From London & Paris for Ladies and Children 
Established in 1815, 

ENGLISH SPOKEN. 



II MINERAL 1 

From the Sources Cappone, Gastigliom, Qurgitello. 
La Rita and Citara 

exportation it forwarded on receipt of 

IFOIfcTSSIEIbT Sz CO 

38. Strada S. Oaterina a Cliiaja 
NAPLES. 



CAFE RESTAURANT DREHER 

P. TRINCHE I'lifrtiF • 

Largo Carolina , No. 8. 9. 10. 11. 
UAPLES 

Breakfasts, Dinners and Suppers. Choice Italian ami Foreign fas 

Sole Depot in Naples of Dreher's Vienna Beer. 

A LA VILLE DE BORDEAUX 

211. Strada cli Chiaia. Naples. 
SAME PROPRIETOR 

iid assortment of Foreign and Italian fines and Liquors, Table wines, 



2<rJL.i?T-iin s silks 

for 

EXPORTATION 

PERCUOCO BROTHERS 

Via Roma 331, 332. NAPOLI 

Lyons Velvets and Silks Woollen and Cotton Goods 

Shawls and Lace Articles for Mourning 



PENSION HASSLER 

SWISS HOUSE 

Strada S. Teresa a Chiaia 10. 

NAPLES 
NEAR THE ENGLISH CHURCH. 



EXCELLENT KITCHEN AND MODERATE PRICES. 
BY THE SAME PROPRIETOR 

mm mm oh mm\h 

CATANIA. SICILY. 



THE PROTESTANT EPISCOPAL CHURCH 

at faiiicciola ( Island of Ischia ) Bay of Naples. 

There being as yet no Protestant Service whatever in 
the Island of Ischia, an attempt was made during the Spring 
of 1875 to establish what is always so great a boon to 
strangers, especially if invalid, and services were held con- 
tinuously for several months through the kindness of Rev. 
D r Moysey of London. It is now desired to raise a sufficient 
sum to ensure a regular chaplaincy from the 1 st of January 
of- each year until June. 

Subscriptions for this purpose will be acknowledged 
through the « American Register » at Paris and may be 
sent to Miss More. II Tringolo, Casamicciola (Island of 
Ischia), or to Mess rs - 

PONSSEN & CO. 

Palazzo Oalabritto, NAPLES. 

GABRIELE SCOGNAMILLO 

MANUFACTURER & DEALER IN PIANOS 

SUCCESSOR 
of 

oiro h..a.:f:es-A_ 

Pianos to let by the month or the year. 
76. Via Poerio a Chiaia. NAPLES. 



MADAME ELISE ROYER 

LADIES' DRESSMAKER 
OOSTTJls^ES FOB OHILZDIRJHlsr 

Strada della Pace No. 24. 
NAPLES. 




R10NE PRINCIPE A M E D E 

Corso Vittorio Emmanuele 
NAPLES 



M r - Giovanni NoMe, the Proprietor, feels sure that 
the magnificence of this Establishment, the elegance of 
its decorations, its comfort and elevated and healthful 
position, overlooking as it does the whole city and com- 
manding delightful views of Vesuvius, the Gulf of Naples 
and the surrounding mountains, will make his new hotel 
the favorite one with Strangers. 



Mr Nobile is Proprietor of the HOTEL. UNITED STATES, Chiatamone, 
Naples & the GRAND HOTEL DES BAINS, Aeireale, Sicily. 



VICO EQUENSE 

Iw fcliip, m tie Ml to Sorrento 

VILLA CAPOZZI. PENSION ANGLAISE. 



The house is delightfully situated facing the South, 
opposite Vesuvius. There are pleasant walks and drives 
in the neighbourhood, and the locality is an especial 
favorite with persons of artistic tastes. Pension at mod- 
erate prices. 

M rs Dawes, English Proprietress. 

Mm" PONSSKN & Co. 

38. Strada S. Caterina a Chiaia. 
NAPLES 
are 

Agents for the SOUTH ITALIAN WINE COMPANY 

(Lacryma Christi and Falerno Wines) 
and 

for Mess rs Woodhouse & Co's celebrated Marsala. 
Orders for large or small quantities will be promptly executed. 



BRITISH PHARMACY 

31 & 32. Largo Garofalo a Chiaia. 

VALENTINO & SAGGESE 

Successors of the old Pharmacy of the 
British Legation. 

Prescriptions dispensed according 
to the American & British 
Pharmacopeias. 

Patent Medicines & Perfumery. 



D r DEMPSTER 

Surgeon Dentist 

Formerly with D r Burridge 
of Kome, and successor at 
Naples to D r Henry Parmley. 

210. Riviera cli Chiaia. 

Office open from ten till four o'clock 
daily, excepting Sundays. 



33, 34. Strada S. Caterina a Cbiaia 
NAPLES . 

HAIRDRESSERS & PERFUMERS 

Perfumery & Articles for the Toilet 

MANUFACTURERS 
of the 

OELEBBATED N^IPILjIES SOAP. 
English, French & German spoken. 

P. STROMILLO 

WATCHMAKER 

N.° 2. Strada S. Caterina a Chiaia 
NAPLES 

Watches and Jewelry repaired. 
FUR MERCHANT «, rpte r^ma 

Chiaia 147 FLORENCE 

Palazzo Principe d' Ottaiano . 

naples American iamiiy Home. 

PENSION INTERNATIONALE 

FIRST CLASS FAMILY BOARDING HOUSE 
5. Chiatamone 

NAPLES 

ENGLISH, FRENCH & GERMAN SPOKEN. 

IP. JDX SABBATO 

Via Roma 324. 
NAPLES 

Manufacturer of Hats for Ladies and Gentleraen 

UMBRELLAS. 
Speciality: Caps for Gentlemen and Boys. 



i 



MTTEO FORTE 



GREAT ROYAL SHOE MANUFACTORY 

CHIEF DEPOT BRANCH ESTABLISHMENT 

81. Strada di Chiaia Piazza Municipio 

IN" APLBS 

lortoiit fit loots & shoes for his, Gentlemen I Children. 

Prix fixes. 



arte 



REUTLI1TG-ER 

A LA VILLE DE LONDRES 
198. Slrada di Chiaia 199. 
NAPLES 

ghenos tt&g&ome de bung 

Speciality in ready made linen for ladies, Gentlemen and Children. 

i> b o T 

of woollen, silk and colton hosiery — Sorrento Silk Stockings. 

FIXED PRICES 

French, German and English Spoken. 

NAINTRE FRERES (de Paris) 

31. Strada S. Carlo 
NAPLES 

ELECTRO-PLATED WARE 

Plated with Gold & Silver by the electro-chemical 
processes of Ruolz, Elkington & Christofle. Old table ser- 
vices and bronzes renewed. Manufacturers of table services 
of guaranteed white metal silver plated. 



mmmm 



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TO 



StUflilsffi 



